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Components Separation for Abdominal Wall Reconstruction: The Pittsburgh Experience, A Review of 311 Consecutive Single Surgeon Cases
Sanjay Naran, MD1, Patrick Emilife, BS1, Meghan Quigley, BS1, Sameer Shakir, BS1, James Cray, Jr., PhD2, James Russavage, MD1, Vu Nguyen, MD1.
1University of Pittsburgh, Pittsburgh, PA, USA, 2Georgia Health Sciences University, Augusta, GA, USA.

PURPOSE:
Components separation of the abdominal musculature is a mainstay for closing complicated midline and para-median abdominal wall defects. We set out to critically analyze our experience with this operative technique, and in doing so identify prognosticators that affect long-term clinical outcomes.
METHODS:
We retrospectively reviewed all patients who underwent components separation by a single surgeon (JMR) between 2000-2010. Over 40 data points were collected for each patient and examined as to whether they affected long-term clinical outcomes. Demographics including BMI, co-morbidities, and operative details were collected. We documented major and minor complications including hernia recurrence, heamatoma, seroma, ischemia, infection, superficial wound breakdown, and DVT/PE.
RESULTS:
Thus far, we have reviewed 311 patients. Our cohort is 51.5% male, with a mean age of 52.4±13.9 years, BMI of 33.1±8.0 kg/m2, and defect size of 189.4±229.8 cm2. 97.1% had a prior abdominal surgery, and 38.5% had a prior mesh placement. 25.5% underwent concurrent intraoperative bowel enterotomies, and 1.7% required prosthetics for closure. Mean post-operative stay was 7.2±5.1 days, and average follow-up was 2.9±2.4 years. The recurrence rate was 20.9%. Post-operative complications included heamatoma (3.8%), seroma (8.4%), ischemia (1.3%), infection (9.2%), superficial wound breakdown (5.9%), and DVT/PE (3.3%). The presence of a respiratory co-morbidity (p=0.049) was associated with an increased risk of recurrence. The occurrence of any post-operative complication (p<0.001) significantly increased the likelihood of eventual recurrence. We found no association between adverse outcomes and BMI.
CONCLUSION:
This study provides a comprehensive review of the largest single surgeon experience utilizing components separation to date. Patients with respiratory co-morbidities are significantly more likely to have a recurrence; however, in our cohort the components separation technique remains a reliable method of abdominal wall reconstruction even in the setting of co-morbidities thought to be associated with adverse outcomes.


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