Abdominal wall component release is a sensible choice for patients requiring complicated closure of abdominal defects

Abstract

Abdominal wall component release (AWCR) is an operation that frequently restores the abdominal wall integrity in both sick and anatomically complex patients. The patients reported herein are different from the widely reported but somewhat less complex trauma patient, such as following damage control laparotomy. AWCR has acceptable postoperative outcomes in terms of infection, hernia, and fistula rates. We describe the application of AWCR in 63 consecutive patients, in whom only 11 (17%) had complementary prosthesis use. Unlike many previous reports of AWCR in trauma patients, 47 (75%) of these patients had permanent stomas. These patients had undergone a total of 103 prior abdominal operations (mean 1.7 operations, range 0-7); 29 patients had cancer (46%), 11 of which were recurrent, and 16 patients (22%) had serious complications of prior surgery. Interestingly, 20 patients (32%) had both prior abdominal operations and underlying cancer. In a median follow-up of 32months (range 16-120months), only 15 patients (5 of whom had a stoma) developed recurrent abdominal wall hernias with 5 of those being peristomal. No correlation was found between prior abdominal operations, intestinal stomas, and contamination source at time of surgery with recurrence of hernia (p > 0.05). The 41 patients (86%) with an intact abdominal wall (free of recurrent hernia) had a median follow-up of 27months (range 13-117months). Twelve patients (19%) had a source of abdominal/abdominal wall contamination present at the time of AWCR. Only 1 of the 11 patients in whom complementary prosthesis was used developed infection. Other infectious complications were noted in 12 patients (19%), including fistula in 1 patient who required reoperation. AWCR offers acceptable results in very high-risk patients with tolerable postoperative infection rates.