Early outcomes of component separation techniques: an analysis of the Spanish registry of incisional Hernia (EVEREG)

J A Pereira-Rodriguez,M López-Cano,P Hernández-Granados,V Rodrigues-Gonçalves,B Montcusí-Ventura,A Bravo-Salva

doi:10.1007/s10029-021-02449-x

Abstract

AimTo analyze the outcomes of component separation techniques (CST) to treat incisional hernias (IH) in a large multicenter cohort of patients.MethodsAll IH repair using CST, registered in EVEREG from July 2012 to December 2019, were included. Data on the pre-operative patient characteristics and comorbidities, IH characteristics, surgical technique, complications, and recurrence were collected. Outcomes between anterior (ACS) and posterior component separation (PCS) techniques were compared. Risk factors for complications and recurrences were analyzed.ResultsDuring the study period, 1536 patients underwent CST (45.5% females) with a median age of 64.0 years and median body mass index (BMI) of 29.7 kg/m2. ACS was the most common technique (77.7%). Overall complications were frequent in both ACS and PCS techniques (36.5%), with a higher frequency of wound infection (10.6% vs. 7.0%; P = 0.05) and skin necrosis (4.4% vs. 0.1%; P < 0.0001) with the ACS technique. Main factors leading to major complications were mesh explant (OR 1.72; P = 0.001), previous repair (OR 0.75; P = 0.038), morbid obesity (OR 0.67; P = 0.015), ASA grade (OR 0.62; P < 0.0001), COPD (OR 0.52; P < 0.0001), and longitudinal diameter larger than 10 cm (OR 0.58; P = 0.001). After a minimum follow-up of 6 months (median 15 months; N = 590), 59 (10.0%) recurrences were diagnosed. Operations performed in a non-specialized unit were significantly associated with recurrences (HR 4.903, CI 1.64–14.65; P = 0.004).ConclusionCST is a complex procedure with a high rate of complications. Both ACS and PCS techniques have similar complication and recurrence rates. Operations performed in a specialized unit have better outcomes.

Highlights

The component separation technique (CST) has become popular in recent years for incisional hernia (IH) repair [1, 2]
A total of 1193 (77.6%) patients were treated with an anterior components separation (ACS) technique and 343 (22.4%) with a posterior components separation (PCS) technique
A previous larger study (2245 cases) included all types of ventral hernia [19]. The analysis of this series shows that CST is a complex operation, mostly performed in high-risk patients with large major complex hernias, which frequently requires associated procedures and has a high risk of complications

Summary

Introduction

The component separation technique (CST) has become popular in recent years for incisional hernia (IH) repair [1, 2]. The following two main CSTs are being used: anterior components separation (ACS) [3] and posterior components separation (PCS) [4]. In both techniques, a mesh is added to reinforce abdominal wall closure and to promote long-term stability [3–5], and both ACS and PCS techniques have proven to be effective [5–7]. In some cases they represent the last chance to achieve a good quality of life for patients who have to modify their lifestyle due to a hernia [8, 9]. Most of the evidence regarding the use of both CSTs is derived from single experiences or high-volume hospitals [6, 10].

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