Component separation technique versus inlay mesh technique in patients with large incisional hernia

Abstract

Context In large incisional hernias, fascial reapproximation is difficult, and it may lead to hernia recurrence. Component separation (CS) can reconstruct the abdominal wall by functional advancement. Mesh repair (‘inlay’ or ‘bridging’ of the defect) also can be done. But meshes carry risk of infection and visceral erosion. In addition, meshes may separate with time because of the vector forces of the contracting oblique muscles leading to recurrence. Aim of the study This study aimed to evaluate the outcomes in patients with large defects undergoing nonperforator-sparing CS versus standard inlay mesh repair. Settings and design This is a prospective controlled randomized study. Patients and materials A total of 68 patients were included in the study. They were divided into two groups, each including 34 patients. One group was operated with the CS technique and the other with the inlay mesh technique. The patients were observed for postoperative complications and were followed up for 1 year for recurrence. Statistical analysis used Continuous variables were expressed as mean and SD. Categorical variables were expressed as frequencies and percentage. Results There were no statistically significant differences between the two groups regarding the postoperative complications or recurrence rates. The CS technique had less incidence of recurrence than the inlay mesh technique. Conclusion The choice of surgical approach in large incisional hernia is difficult. In the current study, the CS technique was better regarding the shape of the abdominal contour than the inlay mesh technique with less incidence of complications such as adhesions of the bowel to the mesh and hernia recurrence.