Abstract: Objective:To investigate the application value of anterior component separation technique (CST) and transversus abdominis release (TAR) technique in the treatment of patients with midline ventral large incisional hernia (LIH).
Methods:The retrospective crosssectional study was adopted. The clinical data of 24 patients with midline ventral LIH who were admitted to the Shanghai Ninth People′s Hospital Affiliated to the Shanghai Jiaotong University School of Medicine from October 2013 to June 2016 were collected. The patients underwent reinforced repair with open CST, endoscopic component separation technique (ECST) and open TAR. Observation indices: (1) operative indices: surgical method, operation time, volume of intraoperative blood loss, duration of hospital stay. (2) Postoperative complications. (3) Followup situations. The followup using outpatient examination and telephone interview was conducted to detect patients′ survival and recurrence of incisional hernia up to June 2016. Measurement date with normal distribution were represented as ±s.
Results :(1) Operative indices: all the 24 patients underwent successful mesh reinforced repair and reconstruction for abdominal wall defects. Of the 24 patients, 14 received reinforced repair with open CST including 8 with open CST and 6 with perforating vessels preserved CST, 8 received reinforced repair with ECST, 2 received reinforced repair with open TAR. The operation time, volume of intraoperative blood loss, duration of hospital stay were (186± 97)minutes, (318±108)mL, (18.2±10.0)days in the patients receiving reinforced repair with open CST and (209±90)minutes, (251±88)mL, (22.5±12.9)days in the patients receiving reinforced repair with ECST and (206±21)minutes, (281±13)mL, (14.0±2.8)days in the patients receiving reinforced repair with open TAR. (2) Postoperative complications: of the 14 patients receiving reinforced repair with open CST, seroma or hematoma were detected in 2 patients, incisional infection in 2 patients, incision separating from fat liquefaction in 1 patient, and they recovered after symptomatic treatments. One patient of pneumonia and 1 of lateral ventral hernia were detected in the 8 patients receiving reinforced repair with ECST, and they recovered after symptomatic treatment and Sublay mesh reimforced repair, respectively. The 2 patients receiving reinforced repair with TAR recovered well without complications. (3)Followup situations: of the 24 patients , 19 were followed up for (21±9)months. During followup, 1 patient died of heartlung failure, 2 died of recurrence of cancer, and 1 patient with incisional infection who was detected to have hernia reccurrence recovered after readmission and Sublay mesh reinforced repair.
Conclusions: CST with mesh reinforcement is important technique in the repair and reconstruction of midline ventral LIH. Selecting appropriate surgical methods according to individual situation of patients is important to improve therapeutic effects of patients with midline ventral LIH.