Complex Abdominal Wall Defects Research Articles

Asymmetric porous composite hydrogel patch for microenvironment-adapted repair of contaminated abdominal wall defects

Effective antibacterial property and long-term mechanical support are essential for the repair of complex abdominal wall defects associated with infection. However, clinically available repair materials often fail to meet these requirements, resulting in high surgical failure rate and complications. In this study, an asymmetric porous composite hydrogel patch (cCS/PVA@BAC) with antibacterial, anti-adhesion, pro-healing, and durable mechanical support properties is designed for the efficient repair of contaminated abdominal wall defects. By stepwise phase-conversion and soaking method, robust and stable polyvinyl alcohol hydrogel (PVAH) is integrated with the biocompatible multicomponent hydrogel made of chitosan and carboxymethyl chitosan (cCS), and benzalkonium chloride (BAC) is loaded to enhance the antibacterial property. The cCS layer of cCS/PVA@BAC has an extracellular matrix-like porous structure, which can promote fibroblasts adhesion and wound healing. In contrast, the PVAH layer on the other side with a smooth and dense structure, which can reduce fibroblasts adhesion and prevent visceral adhesion. In addition, the composite hydrogel patch has good anti-swelling and anti-deformation properties as well as stable mechanical strength, thus can withstand high intraperitoneal pressure in the wet internal microenvironment. The loaded BAC can efficiently kill bacteria and improve the local inflammatory microenvironment. With these advantages, cCS/PVA@BAC can significantly reduce inflammation, promote tissue remodeling, and accelerate the healing of contaminated abdominal wall defects in the rat model. These findings suggest a potential use of multifunctional hydrogel patch as an ideal material for effective repair of contaminated soft tissue defects.

Anterior component separation technique for abdominal wall closure among patients undergoing colorectal surgery: Short-term outcomes and initial experience

IntroductionThe anterior component separation (ACS) is a technique used for abdominal wall closure performed by dissecting and medially advancing the musculature to achieve tension-free closure. Methodsand Materials:This study reviewed our experience with this procedure as used for complex abdominal wall defects encountered during colorectal surgery in a 7-year period. ResultsSixteen patients were included, with 12 having malignancies and the rest for infectious or inflammatory conditions. Defects ranged from 16–400 cm2 and were mostly located at the midline (56%, n = 9). Five cases required additional flaps for closure, attributed either to the size or area of abdominal involvement where benefits of component separation is more limited. Complications include surgical site infection (n = 4), hematoma (n = 2), seroma (n = 1), and wound dehiscence (n = 2). None required ICU admission or assisted ventilation post-operatively. One patient died who had a preexisting cardiac pathology, and the rest were discharged improved. ConclusionThis study demonstrates use of this modality for autologous reconstruction of complex appropriately sized abdominal wall defects from multiple etiologies. Adjunct flaps may be used to achieve reconstruction particularly in areas wherein the effectiveness of ACS is limited. While the study is able to describe immediate outcomes, long-term follow-up is recommended.

Prevention of component separation in complex abdominal wall surgery by Botox prehabilitation: a propensity-matched study.

To facilitate midline fascial closure in complex abdominal wall surgery, component separation techniques (CST) are usually required. However, CST is associated with an enlarged morbidity. Prehabilitation could increase the compliance of the abdominal wall and thereby decrease the necessity of myofascial release. This can be accomplished by administration of botulinum toxin type A (BTA) in the lateral abdominal wall musculature. The aim of this study was to determine the effect of BTA on the subsequent necessity to perform CST in patients with complex abdominal wall hernias. Patients with a complex abdominal wall hernia, planned to undergo CST between July 2020 and November 2022 were included. Outcome of procedures with 300U of BTA 4 (2-6) weeks prior to surgery, were retrospectively analyzed by comparison with propensity matched subjects of an historical group. Hernia width difference was assessed by CT and operative details were included. A total of 13 patients with a median hernia width of 12cm (IQR 9-14, range 24) were prehabilitated with BTA between July 2020 and November 2022. A CST was planned for all, however not required in 6/13 patients (46%) to accomplish midline fascial closure. A mean elongation of lateral abdominal wall musculature of 4.01cm was seen in patients not requiring CST. Compared to the propensity score matched control group, a 27% reduction (p = 0.08) in the need for CST was observed. There is a tendency for decrease of necessity for CST by preoperatively administered BTA in patients with complex abdominal wall defects. Although small, as this study used propensity matched comparison, further exploration of BTA should be encouraged.

Comparison of Two Versus Three Bilateral Botulinum Toxin Injections Prior to Abdominal Wall Reconstruction.

Background: Intramuscular injection of botulinum toxin A (BTA) induces a temporary muscle paralysis. In patients with a ventral hernia, preoperative injection of BTA in the muscles of the lateral abdominal wall (LAW) leads to thinning and lengthening of these muscles, making fascial closure more likely. In many hernia centres, treatment with BTA prior to abdominal wall reconstruction has therefore become standard care. However, evidence on the optimal BTA strategy is lacking. Methods: In this single-centre retrospective study, we analysed a consecutive cohort of ventral hernia patients that underwent bilateral BTA injections prior to abdominal wall reconstruction with available CT before and after BTA. We only included patients that were treated with exactly 600 units of Dysport®, diluted into 120mL of saline, via either two- or three injections on each side into all three LAW muscle layers. The primary outcome was the change in LAW muscle length and thickness, comparing CT measures from before BTA and 4-6weeks after the injections. Results: We analysed 67 patients; 30 had received two injections bilaterally and 37 had received three injections bilaterally. Baseline data showed no significant differences in LAW muscle thickness or length between groups. In both groups, the median LAW muscle thickness decreased with 0.5cm (p < 0.001). The LAW muscle length increased with 0.9cm (p = 0.001) and 1.2cm (p < 0.001) in the two- and three bilateral injection group, respectively. The BTA-induced changes in LAW thickness and length were not significantly different between both groups (p = 0.809 and p = 0.654, respectively). Discussion: When using the exact same dosage and distribution volume of BTA in patients with a complex abdominal wall defect, two injections bilaterally in the lateral abdominal wall muscles are as effective as three injections bilaterally.

OC-045 RECURRENCE AFTER RETROMUSCULAR REPAIR OR POSTERIOR COMPONENTS SEPARATION: HOW TO ADDRESS THEM. A RETROSPECTIVE MULTICENTRE COHORT STUDY

Abstract Introduction Abdominal wall hernias are common entities that represent important issues. Retromuscular repair and component separation for complex abdominal wall defects are considered useful treatments according to both short and long-term outcomes. The aim of this study is to analyse results of surgical treatment for hernia recurrence after prior retromuscular or posterior components separation. Material and Methods We have retrospectively reviewed patient charts from a prospectively maintained database. This study was conducted in three different hospitals of the Madrid region with surgical units dedicated to abdominal wall reconstruction. We have included in the database 520 patients between December 2O14 and December 2021. Results Fifty-one patients complied with the criteria to be included in this study. Thirty-three patients had midline defects, 9 patients a combination of midline and lateral defect, 4 lateral defects alone and 5 patients parastomal hernia. We managed those patients with different approaches. We have found 11,5% surgical site infection rate and surgical site ocurrencies rate was 33,3%. We identified 3 patients with hernia recurrence. One patient died during postoperative course. Conclusions Treating hernia recurrences after retromuscular or posterior components separation is a challenge. Several reconstructive techniques might be planed and adapted to patients with complex abdominal wall defects. We have widely used components separation procedures to treat this type of recurrences. Although technically challenging, reoperation of hernia recurrence after posterior component separation or retromuscular repair should be considered in experienced centres with promising results, even though we may expect severe complications.

Recurrence after retromuscular repair or posterior components separation: How to address them. A retrospective multicentre cohort study

Abdominal wall hernias are common entities that represent important issues. Retromuscular repair and component separation for complex abdominal wall defects are considered useful treatments according to both short and long-term outcomes. However, failure of surgical techniques may occur. The aim of this study is to analyze results of surgical treatment for hernia recurrence after prior retromuscular or posterior components separation. We have retrospectively reviewed patient charts from a prospectively maintained database. This study was conducted in three different hospitals of the Madrid region with surgical units dedicated to abdominal wall reconstruction. We have included in the database 520 patients between December 2014 and December 2021. Fifty-one patients complied with the criteria to be included in this study. We should consider offering surgical treatment for hernia recurrence after retromuscular repair or posterior components separation. However, the results might be associated to increased peri-operative complications.

Repair of a complex abdominal wall defect with anterolateral thigh flap: a good surgical alternative

Repair of a complex abdominal wall defect with anterolateral thigh flap: a good surgical alternative

Recurrence after retromuscular repair or posterior components separation: How to address them. A retrospective multicentre cohort study

Abdominal wall hernias are common entities that represent important issues. Retromuscular repair and component separation for complex abdominal wall defects are considered useful treatments according to both short and long-term outcomes. However, failure of surgical techniques may occur. The aim of this study is to analyze results of surgical treatment for hernia recurrence after prior retromuscular or posterior components separation. We have retrospectively reviewed patient charts from a prospectively maintained database. This study was conducted in three different hospitals of the Madrid region with surgical units dedicated to abdominal wall reconstruction. We have included in the database 520 patients between December 2014 and December 2021. Fifty-one patients complied with the criteria to be included in this study. We should consider offering surgical treatment for hernia recurrence after retromuscular repair or posterior components separation. However, the results might be associated to increased peri-operative complications.

Posterior component separation with TAR: lessons learned from our first consecutive 52 cases.

Patients with complex incisional hernia (IH) is a growing and challenging category that surgeons are facing in daily practice and represent indeed a technical challenge for most of them. The posterior component separation with TAR (PCS-TAR) has become the procedure of choice to repair most complex abdominal wall defects, including those with loss of domain, subxiphoid, subcostal, parastomal or after trauma and sepsis treated initially with "open abdomen" and in those scenarios in which the fascia closure was not performed to avoid an abdominal compartment syndrome. Most recent studies showed that the PCS-TAR represents a valid procedure in recurrent IH. The purpose of our study is to evaluate the reproducibility of the PCS-TAR, describing our experience, our surgical technique and the rate of postoperative complications and recurrences in a cohort of consecutive patients. 52 consecutive patients with complex IH, who underwent PCS-TAR at "Betania Hospital and Ospedale del Mare Hospital" in Naples between May 2014 and November 2019 were identified from a prospectively maintained database and reviewed retrospectively. There were 36 males (69%) and 16 females (31%) with a mean age of 57.88 (range 39-76) and Body mass index (BMI kg/m2) of 31.2 (24-45). More than half of patients (58%) were active smokers. Mean defect width was 13.6cm (range 6-30) and mean defect area was about 267.9cm2. Mean operative time was 228min. Posterior fascial closure was reached in all cases, while anterior fascial closure only in 29 cases (56%). Mean hospital stay was 5.7days. 27% of patients developed minor complications (Clavien-Dindo grade I-II) and one case (1.9%) major complication (Clavien-Dindo III). Seroma was registered in 23% of cases. SSI was reported to be 3.8% with no deep wound infection. Recurrence rate was 1.9% in a mean follow-up of 28months. In Univariate analysis Bio-A surface > 600cm2 and drain removal at discharge were significantly associated with major complications, while in a multivariate analysis only Bio-A surface > 600cm2 was related. Considering univariate analysis for recurrences, number of drains, SSO, Clavien-Dindo score > 2 and defect area were significantly associated with recurrence, while in a multivariate analysis no variables were related. PCS-TAR is an indispensable tool in managing complex ventral hernias associated with a low rate of SSO and recurrence. Tobacco use, obesity and comorbidities cannot be considered absolute contraindications to PCS-TAR. Peri and postoperative management of complications and drainages have an impact on short term outcomes. Based on these outcomes, posterior component separation with transversus abdominis release has become our method of choice for the management of patients with complex ventral hernia requiring open hernia repair in selected patients.

Transversus abdominis release (TAR) procedure: a retrospective analysis of an abdominal wall reconstruction group

Complex abdominal wall defects are important conditions with high morbidity, leading to impairment of patients' physical condition and quality of life. In the last decade, the abdominal wall reconstruction paradigm has changed due to the formation of experienced and excellence groups, improving clinical outcomes after surgery. Therefore, our study shows the perspective and outcomes of an abdominal wall reconstruction group (AWRG) in Colombia, focused on the transverse abdominis release (TAR) procedure. A retrospective review of a prospectively collected database was conducted. All the patients older than 18 years old that underwent TAR procedures between January 2014–December 2020 were included. Analysis and description of postoperative outcomes (recurrence, surgical site infection (SSI), seroma, hematoma, and re-intervention) were performed. 47 patients underwent TAR procedure. 62% of patients were male. Mean age was 55 ± 13.4 years. Mean BMI was 27.8 ± 4.5 kg/m2. Abdominal wall defects were classified with EHS ventral Hernia classification having a W3 hernia in 72% of all defects (Mean gap size of 11.49 cm ± 4.03 cm). Mean CeDAR preoperative risk score was 20.5% ± 14.5%. Preoperative use of BOTOX Therapy (OR 1.0 P 0.00 95% CI 0.3–1.1) or pneumoperitoneum (OR 0.7 P 0.04 95% CI 0.3–0.89) are slightly associated with postoperative hematoma. In terms of hernia relapse, we have 12% of cases; all of them over a year after the surgery. TAR procedure for complex abdominal wall defects under specific clinical conditions including emergency scenarios is viable. Specialized and experienced groups show better postoperative outcomes; further studies are needed to confirm our results.

P-014 RISK FACTORS FOR SHORT- AND LONG-TERM COMPLICATIONS FOLLOWING VENTRAL HERNIA REPAIR WITH THE PERITONEAL FLAP TECHNIQUE

Abstract Aim The peritoneal flap technique has been introduced for the repair of complex abdominal wall defects. The present study was conducted to determine the association between preoperative risk factors and the incidence of short and long-term complications. Material &amp; Methods Patients undergoing abdominal wall repair between January 2010 and September 2020 were included in the study. Patient files were retrospectively reviewed and the presence of risk-factors and the incidence of postoperative short and long-term complications were recorded. A multivariable logistic regression analysis was used to estimate odds ratio (OR) for postoperative complications. Results 327 patients were included. 48.0% were male. Median body mass index(BMI) was 30.9, 13.8% had diabetes and 23.2% were active smokers. Median defect size was 8 cm2 and median mesh size was 667.5 cm2. Median length of hospital stay was 5 days. 13.1% of patients developed a superficial wound infection, 10.4% seroma and 1.2% skin necrosis. Chronic pain was observed in 4.6% and recurrence in 2.4%. The regression analysis demonstrated a stepwise increase in OR for short and long-term complications. This risk was increased by 10% per unit BMI (P&amp;lt;0.01). Smoking and hernial defect size contributed only to a minor extent to the risk of postoperative complications. Conclusion The peritoneal flap method is a safe procedure associated with a low risk of recurrence. The risk of complications is associated with BMI whereas smoking and hernial defect size only contributes to a minor extent.

OC-010 RESULTS OF PREHABILITATION IN PATIENTS WITH COMPLEX ABDOMINAL WALL DEFECTS

Abstract Aim Complex abdominal wall reconstruction (CAWR) remains challenging, even in expert centers. Complication rates are still high, especially in patients with modifiable risk factors (MRF) like obesity, smoking, or diabetes. For several surgical trajectories, prehabilitation of MRF has shown to reduce complication rate. The purpose of this study was to determine the effect of prehabilitation in high risk MRF patients undergoing CAWR on convalescence. Materials and Methods A retrospective cohort study was performed in an expert hernia center. All patients undergoing complex abdominal wall defect reconstruction (hernia width beyond 10 cm, contaminated surgical field or relevant comorbidities) between 2015 and 2019 were included. Each patient was discussed in a multidisciplinary meeting, after which those referred for prehabilitation were compared to those with direct approval. Focus of a supervised preconditioning program could be weight loss, smoking cessation, physical training or a combination. Results From 418 patients discussed, 259 patients underwent CAWR and were included for analysis, of which 126 (49%) underwent prehabilitation. Hernia and intra-operative characteristics were comparable. BMI (28vs30, p&amp;lt;0.001), HbA1c (41vs48, p=0.014), active smokers (4%vs25%, p&amp;lt;0.001) and risk factors (14%vs48%, p&amp;lt;0.001) were higher in the latter group. After prehabilitation, characteristics were comparable. There were no significant differences in postoperative outcome measures (hospital stay 6[5–8]vs6[5–8] days, p=0.908, complication rate 39%vs33%, p=0.190). Conclusions Prehabilitation of modifiable risk factors is profitable in patients planned for CAWR. Subsequent postoperative results were comparable to those without or with less risk factors: prehabilitation downgrades high risk patients to low risk patients. Prospective research is advised.

A staged reconstruction technique utilizing bioprosthetic mesh reinforcement in the repair of giant omphalocele

Reconstruction of complex anterior abdominal wall defects, such as giant omphaloceles, remains a reconstructive challenge for plastic and pediatric surgeons. Though several repair techniques have been described in the literature, no standardized method has been explicitly developed to treat pediatric patients. The utilization of intraabdominal tissue expanders to augment the abdominal domain has been reported as a potential repair technique. Despite its documented application, substantial controversy remains regarding tissue expander implementation due to its associated complications. We describe a staged reconstruction technique with acellular dermal matrix-assisted musculofascial reconstruction followed by delayed skin closure. Utilization of this bioprosthetic mesh in the reconstruction of anterior abdominal wall defects is well-described in the adult population. We applied the principle to a preschool-aged child with a giant omphalocele. This technique provides a medium to bolster the musculofascia, limit the formation of visceral adhesions, decrease the need for numerous procedures, and reduce the risk of infection or pulmonary compromise. This report denotes that a bioprosthetic mesh reinforcement technique may be utilized for functional reconstruction of large, complex abdominal wall malformations in the pediatric population. • What is currently known about this topic? • Giant omphalocele repair methods using tissue expansion have been described. However, these patients remain a reconstructive challenge due to high complication rates. • What new information is contained in this article? • Description of a staged reconstruction using bioprosthetic mesh musculofascial reconstruction with delayed skin closure to repair giant omphalocele in a preschool-aged child.

Surgery for Complex Abdominal Wall Defects: Update of a Nine-Step Treatment Strategy.

Complex abdominal wall defects (CAWDs) are a new surgical entity that require a dedicated and multidisciplinary approach. The spectra of CAWDs and complex abdominal wall reconstruction (CAWR) are poorly defined, and may include any of these elements: large or multiple recurrent hernia, presence of previously placed mesh (open or laparoscopic), loss of abdominal wall domain due to trauma, infection or tumor resection, hernia in the presence of enterocutaneous or enteroatmospheric fistulae (ECF/EAF), hernia in the presence of infected sinus tract, large debilitating parastomal hernia, hernias in the presence of synthetic erosion into the bowel or causing intestinal obstruction, eroded hernias post open abdomen management with skin graft in the presence of intraabdominal catastrophe or massive trauma, and hernias (umbilical or ventral/incisional) in patients with cirrhosis in the presence of massive ascites. The relevance of abdominal wall reconstruction with reinforcement using synthetic or biological mesh has never been as high as it is now. In particular, the use of biological mesh is rising exponentially due to its inherent properties. We previously described a nine-step approach to the management of difficult abdomen with enterocutaneous fistula. In this paper, we update this strategy based on our recent experience with almost 300 patients at our institution who underwent CAWR. Special attention is paid to the management of contaminated fields and the rationale of using biological mesh.

Microvascular Free Tissue Transfer for Reconstruction of Complex Abdominal Wall Defects.

Patients with significant loss of abdominal wall soft tissue represent a reconstructive challenge. The purpose of this study was to describe the authors' experience using microvascular free tissue transfer to repair complex abdominal wall defects with insufficient overlying soft tissue. In this report, the authors highlight their techniques and experiences in performing microvascular free tissue transfer to the abdominal wall for these massive, complex defects. In total, 14 patients who underwent 16 free-flap reconstructions were included in the series. The patients' mean age was 50 ± 14 years, and mean body mass index was 27 ± 5 kg/m2. The mean hernia defect size was 412 ± 149 cm2. Ten flaps were fasciocutaneous anterolateral thigh flaps, one myocutaneous anterolateral thigh flap, two subtotal thigh flaps, one myocutaneous latissimus dorsi flap, one parascapular/latissimus dorsi flap, and one free filet of the lower leg. Five cases (36 percent) developed hernia recurrence, and seven developed surgical site complications. All flaps survived, with no total flap loss. This report highlights that microsurgical free tissue transfer in combination with mesh repair is a safe and reliable method for restoring complex, large, full-thickness abdominal wall defects. This case series illustrates a number of techniques and considerations that are of importance to achieve a favorable outcome when faced with these complex defects. Therapeutic, IV.

Abdominal Wall Vascularized Composite Allotransplantation: A Scoping Review.

Abdominal wall vascularized composite allotransplantation (AW-VCA) is a novel reconstructive technique used for large abdominal wall defects in combination with intestinal transplantation (ITx) or multivisceral abdominal transplantation (MVTx). Since the introduction of this procedure, several studies have been published reporting their experience. This study aims to present a scoping review looking at all available evidence-based medicine information to understand the most current surgical techniques and clinical outcomes. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) extension for scoping reviews checklist. A comprehensive research strategy of several databases was conducted. A total of 31 studies were included in this review, which comprised animal, cadaveric, and human studies. In human studies, four surgical techniques with high flap survival rates and low complication rates were found. In cadaveric studies, it was shown that the use of iliofemoral cuff-based flaps provided adequate tissue perfusion to the abdominal wall graft. Also, the use of thoracolumbar nerves have been described to provide functionality to the AW-VCA and prevent long-term muscle atrophy. AW-VCA is a safe and efficient alternative for patients with large and complex abdominal wall defects. The future holds a promising evolution of a functional AW-VCA, though surgeons must face and overcome the challenge of distorted anatomy frequently present in this population. Forthcoming studies with a better level of evidence are required to evaluate functionality and differences between surgical techniques.

VP15.08: First trimester diagnosis of body stalk anomaly

Body stalk anomaly is a lethal and complex abdominal wall defect. The exact pathophysiology and trigger factors of this rare, multisystem severe malformation syndrome are still unknown. We present case of an 18-year-old primigravida who was referred for nuchal translucency scan. Examination revealed an abnormal location of the abdominal contents of the fetus in the coelomic space. Stomach, liver, small bowel loops and dilated urinary bladder were seen protruding out of the abdominal wall defect into the coelomic space. Remaining fetus was in amniotic cavity. A short umbilical cord running through the amniotic membrane was noted. Other findings included asymmetric ventriculomegaly, sacral agenesis and kyphoscoliosis. Rest of the fetus appeared normal for gestation. These ultrasonographic findings were consistent with body stalk anomaly. This severe malformation being incompatible with life, the patient decided for termination of pregnancy. Pathologic examination confirmed the suspected diagnosis of body stalk anomaly. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Components separation technique of the abdominal wall: Which muscle release produces the greatest reduction in tension on the mideline?

The components separation technique (CS) is used for the reconstruction of complex abdominal wall defects. Release and undermining of the rectus abdominis muscle (RAM) and external oblique muscle (EOM) decrease tension on the abdominal midline, reducing recurrence of ventral hernia, but causes major changes in the physiology of abdominal wall. The purpose of the study was to determine which muscle release and undermining produces the lowest tension on the midline. Twenty fresh cadavers were dissected and the anterior and posterior layers of the rectus sheath were isolated in the midline. The forces necessary to advance the layers of the rectus sheath to the mid abdomen were measured bilaterally at two points located 3 cm above and 2 cm below the umbilicus, and at 3 different stages: before any muscle release; after release and undermining of the right RAM and left EOM; and after release and undermining of the left RAM and right EOM. Comparisons of tensile forces were conducted separately for the different muscles involved, layers of the rectus sheath, measurement points, and stages of separation. Tension on the abdominal midline after the release and undermining of both the RAM and EOM was reduced by 56% (p <0.05), 42% after the release and undermining of the EOM alone (p <0.05), and 35% after release and undermining of the RAM alone (p <0.05). Release and undermining of the EOM by CS led to lower tension on the abdominal midline compared to that associated with the release of the RAM alone.

Application of 3D Visualization Technology in Complex Abdominal Wall Defects.

PurposeTo explore the value of medical three-dimensional visualization technology in precise preoperative assessment of complex abdominal wall defects.MethodsThe clinical data of 30 patients were analyzed retrospectively from November 2017 to December 2020 in our department. Ten patients had abdominal wall hernias and 20 patients suffered from abdominal wall tumors. CT examination was performed, and data were stored in the form of DICOM. Three-dimensional reconstruction and related data analysis were performed by Medraw software, which can accurately show the calculation of the abdominal wall defect area, abdominal wall defect classification and zoning.ResultsThe ratio of the volume of the hernia sac to the whole abdominal volume in 10 patients with abdominal wall hernia was 4.75%. The average ratio of defect area to the whole abdominal wall in 16 patients suffered from abdominal wall tumors was 17.68%. Preoperative three-dimensional reconstruction can accurately obtain an average abdominal wall defect area of 227.83 ± 157.33 cm2 and accurate abdominal wall classification and zoning. Combined with clinical information, we can develop personalized surgical plans for patients. The average operating time was 5.39 ± 2.71 h, respectively, and the average hospital stay was 22.77 ± 11.59 days. The mean follow-up time was 21.09 ± 9.72 months. The incidence of postoperative complications was 23.33% (7/30). The recurrence rates of incisional hernias and abdominal wall tumors were 20.00% (2/10) and 15.00% (3/20), respectively. The patient survival rate was 86.67% (26/30).ConclusionThree-dimensional visualization technology can be used for the accurate evaluation of patients with complex abdominal defects before surgery and can help surgeons design personalized surgical plans for patients.

Beyond the Hernia Repair: A Review of the Insurance Coverage of Critical Adjuncts in Abdominal Wall Reconstruction

Insurance companies were selected based on their national and state market share. Preauthorization criteria, preauthorization lists, and medical/clinical policies by each company for component separation, SVRH-P, and SVRH-A were examined. Coverage criteria were abstracted and analyzed. Fifty insurance companies were included in the study. Only 1 company had clear approval criteria for component separation, while 38 cover it on a case-by-case basis. Four companies had clear approval policies for SVHR-P, 4 cover them on an individual case basis, and 28 flatly do not cover SVHR-P. Similarly, 3 companies had clear approval policies for SVHR-A, 6 cover them case by case, and 33 do not cover SVHR-A. Component separation and soft tissue contouring are important adjunctive AWR procedures with efficacy supported by peer-reviewed literature. The variability in SVHR-P and SVHR-A coverage likely decreases access to these procedures even when there are established medical indications. The authors recommend standardization of coverage criteria for component separation, given that differing interpretations of medical necessity increase the likelihood of insurance denials.