Complex Ventral Hernia Research Articles

Long-Term Outcomes of Component Separation for Abdominal Wall Hernia Repair.

Component separation is a reconstructive technique used to facilitate midline closure of large or complex ventral hernias. Despite a contemporary surge in popularity, the incidence and long-term outcomes after component separation remain unknown. To evaluate the incidence and long-term outcomes of component separation for abdominal wall hernia repair. This cohort study examined 100% Medicare administrative claims data from January 1, 2007, to December 31, 2021. Participants were adults (aged ≥18 years) who underwent elective inpatient ventral hernia repair. Data were analyzed from January through June 2024. Use of component separation technique during ventral hernia repair. The primary outcomes were the incidence of component separation over time and operative recurrence rates up to 10 years after surgery for hernia repairs with and without component separation. The secondary outcome was rate of operative recurrence after component separation stratified by surgeon volume. Among 218 518 patients who underwent ventral hernia repair, the mean (SD) age of the cohort was 69.1 (10.9) years; 127 857 patients (58.5%) were female and 90 661 (41.5%) male. A total of 23 768 individuals had component separation for their abdominal wall hernia repair. The median (IQR) follow-up time after the index hernia surgery was 7.2 (2.7-10) years. Compared with patients who did not have a component separation, patients undergoing repair with component separation were slightly younger; more likely to be male; and more likely to have comorbidities, including obesity, and had surgeries that were more likely to be performed open and use mesh. Proportional use of component separation increased from 1.6% of all inpatient hernia repairs in 2007 (279 patients) to 21.4% in 2021 (1569 patients). The 10-year adjusted operative recurrence rate after component separation was lower (11.2%; 95% CI, 11.0%-11.3%) when compared with hernia repairs performed without component separation (12.9%; 95% CI, 12.8%-13.0%; P = .003). Operative recurrence was lower for the top 5% of surgeons by component separation volume (11.9%; 95% CI, 11.8%-12.1%) as opposed to the bottom 95% of surgeons by volume (13.6%; 95% CI, 13.4%-13.7%; P = .004). This study found that component separation was associated with a protective effect on long-term operative recurrence after ventral hernia repair among Medicare beneficiaries, which is somewhat unexpected given the intent of its use for higher complexity hernias. Surgeon volume, while significant, had only a minor influence on operative recurrence rates.

Ventral Hernia Repair With a Hybrid Absorbable-permanent Preperitoneal Mesh.

To analyze device safety and clinical outcomes of ventral hernia repair with the GORE SYNECOR Preperitoneal Biomaterial (PRE device), a permanent high-strength mesh with bioabsorbable web scaffold technology. This multicenter retrospective review analyzed device/procedure endpoints and patient-reported outcomes in patients treated for hernia repair ≥1 year from study enrollment. Included in this analysis were 148 patients with a mean age of 56 years; 66.2% met the Ventral Hernia Working Group grade 2 classification. Median hernia size was 30.0cm 2 and 58.8% of patients had an incisional hernia. Repairs were primarily a robotic (53.4%) or open approach (41.9%). All meshes were placed extraperitoneal. Procedure-related adverse events within 30 days occurred in 13 (8.8%) patients and included 7 (4.8%) patients with surgical site infection, 2 (1.4%) with surgical site occurrence (SSO), 4 (2.7%) requiring readmission, and 3 (2.0%) who had reoperation. The rate of SSO events requiring procedural intervention was 2.7% (4 patients) through 30 days and 3.4% (5 patients) at 12 months. The rate of procedure-related surgical site infection remained at 4.8% through 12 months (no further reports after 30d) and 3.4% for SSO (2 reports after 30d). There were no site-reported clinically diagnosed hernia recurrences throughout the study. Median patient follow-up including in-person visit, physical examination, reported adverse event, explant, death, and questionnaire response was 28 months (n = 148). Median patient follow-up with patient questionnaire was 36 months (n = 88). Use of the PRE device, which incorporates the proven advantages of both an absorbable synthetic mesh and the long-term durability of a permanent macroporous mesh, is safe and effective in complex ventral hernia repairs. When used in the retromuscular space, the combination of these 2 materials had lower wound complications and recurrence rates than either type of material alone.

Socioeconomic inequalities in patients undergoing abdominal wall reconstruction in the North-West of England, UK: a three-centre retrospective cohort study

PurposePatients from deprived areas are more likely to experience longer waiting times for elective surgery, be multimorbid, and have inferior outcomes from elective and emergency surgery. This study aims to investigate how surgical outcomes vary by deprivation for patients undergoing elective abdominal wall reconstruction.MethodsA three-centre retrospective cohort study was conducted across three hospitals in North-West England, including patients with complex ventral hernias undergoing abdominal wall reconstruction between 2013 and 2021. Demographic data, comorbidities, and index of multiple deprivation quintiles were recorded.Results234 patients (49.6% female), age 57 (SD 13) years, underwent elective abdominal wall reconstruction. Significantly higher unemployment rates were found in the most deprived quintiles (Q1 and Q2). There were more smokers in Q1 and Q2, but no significant deprivation related differences in BMI, diabetes, chronic kidney disease or ischaemic heart disease. There were also higher rates of Clavien-Dindo 1–2 complications in Q1 and Q5, but no difference in the Clavien-Dindo 3–4 outcomes. Patients in Q1 and Q5 had a significantly greater hospital length of stay.ConclusionThe association between deprivation and greater unemployment and smoking rates highlights the potential need for equitable support in patient optimisation. The lack of differences in patient co-morbidities and hernia characteristics could represent the application of standardised operative criteria and thresholds. Further research is needed to better understand the relationship between socioeconomic status, complications, and prolonged hospital length of stay.

Elective complex ventral hernia repair in contaminated fields: A propensity score–matched analysis of long-term quality of life and outcomes between different prostheses

BackgroundRandomized studies have endorsed nonabsorbable prosthetics for contaminated ventral hernia surgery, yet the broader applicability and impact on patient-reported outcomes are still questioned. Here, we evaluated the long-term outcomes of elective contaminated ventral hernia repairs (based on Centers of Disease Control and Prevention [CDC] wound classification) using real-world data from a multicenter US cohort, focusing on quality of life and postoperative pain. MethodsThe Abdominal Core Health Quality Collaborative database was queried for patients undergoing elective contaminated (CDC class II–IV) ventral hernia repair (2013–2023). After propensity matching, we compared long-term differences in patient-reported quality of life and pain scores (by HerQLes and PROMIS questionnaires) among those who underwent repair with nonabsorbable, absorbable synthetic, and biologic mesh. ResultsA total of 1,073 patients were included, of whom 920 (86%), 56 (5%), and 97 (9%) underwent repair with nonabsorbable, absorbable synthetic, and biologic mesh, respectively. Among them, the median age was 62 years (interquartile range [IQR] 53–70), and 523 (49%) were male. The median length and width of the defect were 20 cm (IQR 12–25) and 13 cm (IQR 8–16), respectively. A transversus abdominis release was performed in 716 patients (67% of all cases). In most cases, the mesh was positioned in the retro-rectus (85%) and/or the preperitoneal space (45%). Before and after propensity matching (n = 185), the change from baseline in HerQLes and PROMIS scores at 6 months and at 1, 3, 5, and 6 years was comparable between different types of mesh. Lastly, there were no differences in readmission, surgical site infection, or surgical site occurrence at 30 days. Recurrence at 1 year was also comparable among groups. ConclusionIn the long term, there were no differences in quality of life or pain scores with nonabsorbable, absorbable synthetic, or biologic mesh for elective ventral hernia repair in contaminated fields.

Outcomes after open posterior component separation via transversus abdominis release (TAR) for incisional hernia repair. A systematic review and meta-analysis.

Given its potential advantages, open Transversus Abdominis Release (oTAR) has been proposed as a durable solution for complex AWR. However, its applicability in different scenarios remains uncertain. We aimed to analyze the current available evidence and determine surgical outcomes after oTAR. We performed a systematic electronic search on oTAR in PubMed/Medline, Embase, and Cochrane Central Register of Controlled Trials databases. Postoperative morbidity and recurrence rates were included as primary endpoints and Quality of life (QoL) was included as secondary endpoint. A random-effect model was used to generate a pooled proportion with 95% confidence interval (CI) between all studies. A total of 22 studies with 4,910 patients undergoing oTAR were included for analysis. Mean hernia defect and mesh area were 394 (140-622) cm2 and 1065 (557-2206) cm2, respectively. Mean follow-up was 19.7 (1-32) months. The weighted pooled proportion of recurrence, overall morbidity, surgical site occurrences (SSO), surgical site infection (SSI), surgical site occurrences requiring procedural intervention (SSOPI), major morbidity and mortality were: 6% (95% CI, 3-10%), 34% (95% CI, 26-43%), 22% (95% CI, 16-29%), 11% (95% CI, 8-16%), 4% (95% CI, 3-7%), 6% (95% CI, 4-10%) and 1% (95% CI, 1-2%), respectively. A significant improvement in QoL after oTAR was reported among studies. Open TAR is an effective technique for complex ventral hernias as it is associated with low recurrence rate and a significant improvement in QoL. However, the relatively high morbidity rates observed emphasize the necessity of further patients' selection and optimization to improve outcomes.

Perforator Preserving Anterior Component Separation Technique Combined with Peritoneal Flap Hernioplasty in Patients of Complex Ventral Hernia

Perforator Preserving Anterior Component Separation Technique Combined with Peritoneal Flap Hernioplasty in Patients of Complex Ventral Hernia

Posterior components separation with transversus abdominis release and sublay mesh reinforcement in large ventral hernia repair

AbstractAimVentral abdominal hernia is a prevalent condition among surgical patients. Large ventral hernias with defects >10 cm that cannot be closed primarily, often with loss of domain requiring abdominal wall reconstruction, pose a surgical challenge. Our study aimed to evaluate the outcomes of posterior components separation (PCS) with transversus abdominis release (TAR) and sublay mesh reinforcement in large ventral hernia repair, particularly in terms of surgical site occurrences (SSOs) and hernia recurrence.Patients and MethodsOur study included 40 adult patients presented to Tanta University Hospitals with a large ventral hernia (defect width ≥10 cm) from December 2021 to January 2023. All patients were submitted to PCS with TAR and sublay mesh reinforcement.ResultsThe mean age of the study population was 47.32 (standard deviation [SD] 9.31) years (range 36–65 years) with a mean body mass index of 33.55 (SD 3.42) kg/m2 (range 28.35–38.72 kg/m2). The major risk factors were obesity (95.00%), smoking (45.00%), and multiparity (45.00%). Midline incisional hernia was the most common type in 28 patients (70.00%). Thirty‐four patients (85%) achieved successful midline closure, while six patients required additional anterior components separation technique to achieve tensionless midline closure and an onlay mesh for functional reconstruction. Post‐operative SSOs occurred in 12 patients (30.00%), with subcutaneous seroma in 8 patients (20.00%) and wound dehiscence and necrosis in 4 patients (10.00%). Two patients (5.00%) experienced recurrence after a mean follow‐up period of 19.25 (SD 3.52) months.ConclusionsPCS with TAR and sublay mesh reinforcement is a reliable and durable technique for complex ventral hernia repair with low morbidity and recurrence rates. However, long‐term clinical outcomes with more cases are required to properly evaluate this technique.

The effects of socioeconomic status on complex ventral hernia repair operative decision-making and outcomes

BackgroundPatients from low socioeconomic backgrounds have greater rates of morbidity and mortality across disease processes. The Distressed Communities Index identified several socioeconomic components that were used to create a Distressed Communities Index score for every ZIP code, then broken into quintiles from prosperous to distressed. We aimed to explore whether socioeconomic distress as defined by the Distressed Communities Index affects the outcome of complex ventral hernia repair in the elderly population. MethodsRetrospective analysis was performed using the Abdominal Core Health Collaborative data. Included were adults aged 65+ years undergoing elective complex ventral hernia repair from 2013 to 2021. Primary outcomes were postoperative outcomes and composite hernia recurrence by Distressed Communities Index quintile. The Cox proportional hazards model was used for composite recurrence, and logistic regression was used for postoperative outcomes. ResultsA total of 4,172 patients were included. Patients in distressed communities were more likely to identify as female or racial minority and had greater body mass index and American Society of Anesthesiologists class. Lower Distressed Communities Index quintile was associated with larger hernia (P = .012), open repair (P = .019), and 30-day complication (P = .05). There was no association between time to recurrence and Distressed Communities Index quintile (P = .24). After adjusted analysis, there was no significant difference for readmission, reoperation, recurrence, and complications. ConclusionPatients from more distressed communities presented in worse clinical status with larger hernias. This likely contributed to greater rates of open repair and complications. However, when adjusted for these variables, outcomes were similar across Distressed Communities Index quintile. This supports the efficacy of complex hernia repair across socioeconomic classes.

Feasibility of Posterior Component Separation with Transversus Abdominis release in complex ventral hernias : outcomes and experience at a single centre

Feasibility of Posterior Component Separation with Transversus Abdominis release in complex ventral hernias : outcomes and experience at a single centre

INTRAOPERATIVE FASCIAL TRACTION FOR TREATMENT OF W2 AND W3 VENTRAL HERNIAS

Abstract Background Component separation techniques are increasingly employed in abdominal wall reconstruction surgery. The use of adjuvant techniques, such as intraoperative vertical dynamic fascial traction, enhances the compliance of the abdominal wall. This facilitates closure of the abdominal wall using less disruptive techniques without compromising effective treatment. Our aim is to retrospective review our results regarding the effectiveness and complication rate of intraoperative fascial traction for the treatment of complex ventral hernias. Method Conducted a retrospective analysis of 10 patients who underwent surgery using intraoperative fascial traction for W2 and W3 ventral hernias. Results Preoperatively, fascial distances measured ranged from 55 cm to 145 cm, with the majority of patients (70%) having a fascial distance greater than 10 cm. Most patients received other adjuvant treatments (nine cases with botulinum toxin injection and one with pre-operative progressive pneumoperitoneum). Posterior component techniques were employed in 40% of patients (half with W2 hernias and the other half with W3 hernias). The complication rate was 10%, with one case of hemorrhage requiring percutaneous embolization. During the average 6-month follow-up period (ranging from 1 to 17 months), one recurrence was observed. Conclusion Intraoperative fascial traction is a feasible and safe adjuvant technique for abdominal wall reconstruction. The use of adjuvants in complex abdominal wall hernia surgery may, in some patients, downstage the hernia, thereby avoiding the need for component separation techniques. This approach enables tension-free closure of the abdominal wall in a less invasive manner.

Two-meshes approach in posterior component separation with transversus abdominis release: the IMPACT study (Italian Multicentric Posterior-separation Abdominal Complex hernia Transversus-release).

Surgical management of large ventral hernias (VH) has remained a challenge. Various techniques like anterior component separation and posterior component separation (PCS) with transversus abdominis release (TAR) have been employed. Despite the initial success, the long-term efficacy of TAR is not yet comprehensively studied. Authors aimed to investigate the early-, medium-, and long-term outcomes and health-related quality of life (QoL) in patients treated with PCS and TAR. This multicenter retrospective study analyzed data of 308 patients who underwent open PCS with TAR for primary or recurrent complex abdominal hernias between 2015 and 2020. The primary endpoint was the rate of hernia recurrence (HR) and mesh bulging (MB) at 3, 6, 12, 24, and 36months. Secondary outcomes included surgical site events and QoL, assessed using EuraHS-QoL score. The average follow-up was 38.3 ± 12.7months. The overall HR rate was 3.5% and the MB rate was 4.7%. Most of the recurrences were detected by clinical and ultrasound examination. QoL metrics showed improvement post-surgery. This study supports the long-term efficacy of PCS with TAR in the treatment of large and complex VH, with a low recurrence rate and an improvement in QoL. Further research is needed for a more in-depth understanding of these outcomes and the factors affecting them.

Revisiting large complex ventral hernia repair: multimodal hybrid technique deploying preoperative Botulinum Toxin A injection, laparoscopic anterior components separation and open mesh repair.

In the past, various techniques had been described to repair large complex ventral hernias. Laparoscopic technique of components separation showed low complication rates and better overall outcome. Recently, Botulinum Toxin A (BTA) has shown benefit in achieving tension-free repair. We describe here our multimodal technique combining BTA injection, laparoscopic anterior components separation (LACS) and open mesh repair. Ten consecutive cases performed over 3years were studied. A standardised technique was used with a reasonably short learning curve. Patients who generally fit for general anaesthesia were offered surgery after detailed preoperative imaging work up and informed consent. Demographic details, preoperative risk stratification, intraoperative and postoperative outcomes were recorded and analysed. A structured step by step management strategy was adopted. Total ten (n = 10) cases with median age of 42.5years (range 28-76years), male to female ratio of 8:2 and median BMI of 32.6 were included. Three patients had pre-existing stomas. Median diameter of hernial defect was 10cm, IQR 4.8cm and range of 6-20cm. No intraoperative or immediate complications were observed. Median hospital stay was 6days. Two seromas (20%) and two return to theatre (20%) were observed. One recurrence (10%) was observed after median follow-up of 32months. No 90-day mortality was recorded. Multimodal technique of BTA injection, LACS and midline mesh repair is a reproducible, safe and effective option to repair large complex ventral hernias.

Botulinum Toxin A as an Adjunct for the Repair Giant Inguinal Hernias: Case Reports and a Review of the Literature.

The management of giant inguinoscrotal hernias remains a challenge as a result of the loss of the intra-abdominal domain from long-standing hernia contents within the scrotum. Multiple techniques have been described for abdominal wall relaxation and augmentation to allow the safe return of viscera from the scrotum to the intraperitoneal cavity without adversely affecting cardiorespiratory physiology. Preoperative progressive pneumoperitoneum, phrenectomy, and component separation are but a few common techniques previously described as adjuncts to the management of these massively large hernias. However, these strategies require an additional invasive stage, and reproducibility remains challenging. Botulinum toxin A (BTA) has been successfully used for the management of complex ventral hernias. Its use for these hernias has shown reproducibility and a low side effect profile. In the present report, we describe our institutional experience with BTA for giant inguinal hernias in two patients and present a review of the literature. In one case, a 77-year-old man with a substantial cardiac history presented with a giant left inguinal hernia that was interfering with his activities of daily living. He had BTA six weeks prior to inguinal hernia repair. Repair was performed via an inguinal incision with a favorable return of the viscera into the peritoneum. He was discharged on the same day of the operation. A second patient, 78 years of age, had a giant right inguinoscrotal hernia. He had a significant cardiac history and was treated with BTA six weeks prior to inguinal hernia repair via a groin incision. Neither patient had complaints nor recurrence at 7- and 3-month follow-ups. While the literature on this topic is scarce, we found 13 cases of inguinal hernias treated with BTA as an adjunct. BTA might be a promising adjunct for the management of giant inguinoscrotal hernias in addition to or in place of current strategies.

Abdominal Wall Reconstruction: Advances in the Last Decade

Abstract The incidence of abdominal wall hernia (AWH) is increasing because of the aging population, obesity, and the increasing number of abdominal surgeries performed. Over the last decade, there have been many improvements with the introduction of novel techniques in the management of AWH. The development of component separation and bioprosthetic mesh has transformed the management of complex ventral hernias. An increased number of complex ventral hernia repairs are being done using minimally invasive methods, including component separation. With the introduction of three-dimensional laparoscopic technique and robotic platform, the technique of component separation for abdominal wall reconstruction (AWR) has become more reproducible. In the past decade, the prosthetic materials have greatly improved, including bioengineered smart scaffold tissues such as hydrogel and electrospun fibers that have shown promising results even in infected environment. Apart from advances in complex abdominal wall repair, patient-centric outcomes and the cost-effectiveness of hernia surgery also have gained focus in the management of AWH. Today, the field of hernia has become a discipline in itself due to a better understanding of the biomechanics and pathophysiology of AWHs. There has been a tremendous development in diverse surgical techniques for complex abdominal wall repair with huge advancements in the development of hernia implants transforming it from a simple hernia repair to the science of AWR. This review aims to summarize recent developments in the field of AWR, incorporating a brief overview of the management of AWH.

A pragmatic study of Porcine Acellular Dermal Matrix Mesh in Ventral and Parastomal Hernia repairs. Evaluation of outcomes from a tertiary centre.

Aims and Objectives: Incidence of complex ventral hernias and those with contamination are increasing. Synthetic meshes are not favoured due to increased risk of wound complications. Biologic meshes are used as an alternative given their biocompatible safety, but, there is lack of strong evidence to recommend its routine use. Hence, it is up to institutions to evaluate the safety and efficacy to support its continuing usage, which is the basis of this study.
 
 Methods: A retrospective review of a prospectively maintained PADM mesh database was performed focussing on midline and parastomal hernias. Demographic data, surgical techniques and short- and long-term complications were reviewed.
 
 Results: 71cases, (acute/elective 10/61) were included. The median age group, sex ratio in the acute and elective groups were 67 years (36-83yrs) and 62years (25-93yrs), 2:1 and 4:3 respectively. Mean ASA score was 3.4 in acute and 2.4 in elective group. Midline hernias constituted 37/ 61 (60%) and Parastomal hernias, 40% (24/61). Component separation was performed in 29 cases, which includes bilateral anterior component separation in 16, unilateral anterior component in 11 and posterior component separation in 2. Median length of stay was 11days (1-180d) and 15 days (1-159d) in the elective and acute groups respectively. Median length of follow up was 18 months (12 -72 months). There were 5 deaths within 90 days. Recurrences were noted in 6/37 (16%) midline repairs and 8/24 (33%) parastomal hernias.
 Conclusion: Our limited PADM series showed acceptable results in comparison with available studies. As such we find it a useful adjunct in the repair of complex ventral hernias.

Autologous full-thickness skin in the repair of complex ventral hernias: an innovative step into the future of complex hernia repair?

The repair of complex ventral hernias, such as giant incisional or parastomal hernia, is associated with a high risk for complications and recurrence. Some serious complications are related to implantation of synthetic mesh as reinforcement material. Autologous full-thickness skin graft (FTSG) as reinforcement material in the repair of these complex hernias may offer a safe alternative. This is a review of the history of FTSG use in hernia surgery and the experiences of our research group regarding its application over the last decade. The results of FTSG used in the repair of giant ventral hernias are promising, and this method may already be recommended in selected cases. We have also conducted a translational chain of preclinical studies, based on a murine model, to gain a greater understanding of the behaviour of FTSG implanted in various positions in the abdominal wall. The use of intraperitoneal FTSG as reinforcement material in parastomal hernia repair is currently being evaluated in a randomised, controlled, multicentre study.

Is weight trajectory a better marker of wound complication risk than BMI in hernia patients with obesity?

Complex ventral hernias are frequently repaired via an open transversus abdominis release (TAR). Obesity, particularly a BMI > 40, is a strong predictor of wound morbidity following this procedure. We aimed to determine if preoperative weight loss may still be beneficial in patients with persistently elevated BMIs. A retrospective chart review of patients with obesity (BMI ≥ 30) who underwent open TAR at a tertiary academic medical center from January 2018 to December 2021 was completed. Demographics, medical history, operative details, and postoperative data were analyzed. Weight and BMI were recorded at three time points: > 6months prior to initial surgical consultation, surgical consultation, and day of surgery. In total, 182 patients with obesity underwent an open TAR. Twenty-seven patients (14.8%) underwent surgery with a BMI > 40; they did not have any significant differences in surgical site occurrences (SSO, 48.1% vs 32.9%, p = 0.13) or surgical site infections (SSI, 25.9% vs 23.2%, p = 0.76) compared to those with a BMI ≤ 40.The average timeframe analyzed for preoperative weight loss was 592days. Patients who had at least a 3% weight loss (n = 49, 26.9%) had decreased rates of SSI compared to those who did not have this weight loss (12.2% vs 27.8%, p = 0.03), despite the groups having similar BMIs at the time of surgery (36.4 vs 36.0, p = 0.50). Patients who only had a 1% weight loss did not see a decrease in SSI rate compared to those who did not (20.6% vs 25.4%, p = 0.45). Weight loss may be a better indicator of a patient's risk for wound morbidity following TAR than BMI alone, as weight loss of at least 3% resulted in fewer SSIs despite similar BMIs at time of surgery. Further research into optimal timing and amount of weight loss, as well as effects on long-term outcomes, is needed to confirm these findings.

Determining the Association Between Insurance Type and Myofascial Release in Large Ventral Hernias

IntroductionAbdominal wall reconstruction (AWR) utilizes advanced myofascial releases to perform complex ventral hernia repair (VHR). The relationship between the performance of AWR and disparities in insurance type is unknown. MethodsThe Abdominal Core Health Quality Collaborative was queried for adults who had undergone an elective VHR between 2013 and 2020 with a hernia size ≥10 cm. Patients with missing insurance data were excluded. Comparison groups were divided by insurance type: favorable (private, Medicare, Veteran's Administration, Tricare) or unfavorable (Medicaid and self-pay). Propensity score matching compared the cumulative incidence of AWR between the favorable and unfavorable insurance comparison groups. ResultsIn total, 26,447 subjects met inclusion criteria. The majority (89%, n = 23,617) had favorable insurance, while (11%, n = 2830) had unfavorable insurance. After propensity score matching, 2821 patients with unfavorable insurance were matched to 7875 patients with favorable insurance. The rate of AWR with external oblique release or transversus abdominis release was significantly higher (23%, n = 655) among the unfavorable insurance group compared to those with favorable insurance (21%, n = 1651; P = 0.013). ConclusionsThis study provides evidence that patients with unfavorable insurance may undergo AWR with external oblique or transversus abdominis release at a greater rate than similar patients with favorable insurance. Understanding the mechanisms contributing to this difference and evaluating the financial implications of these trends represent important directions for future research in elective VHR.

Surgical treatment of complex ventral hernia in a patient with colostomy status (colostomy takedown anastomosis and abdominal wall repair)

Surgical treatment of complex ventral hernia in a patient with colostomy status (colostomy takedown anastomosis and abdominal wall repair)

A morbidly obese patient with large incisional hernia managed with posterior compartment separation sub-lay mesh placement

Most of the incisional hernias are diagnosed in first 3 years after the major abdominal surgery but some may take 9-10 years before the presentation after surgery. Risk factors to develop incisional hernia includes patient factors; advanced age, hypertension, diabetes, obesity, anemia, smoking, chronic obstructive pulmonary disease (COPD), immunosuppression, previous coronary intervention, renal disease requiring dialysis, recent weight loss and malnutrition. Surgery related risk factors includes intraoperative complication, suture technique, surgical site infections, fascial dehiscence and other postoperative complications. We are presenting of large incisional hernia, which have managed with posterior compartment separation. Large incisional ventral hernias following abdominal surgeries can pose significant challenges in management and quality of life for both patients. The Rives-Stoppa repair technique provides authentic and essential solution for management of large complex ventral hernias with reducing the risk of recurrence and providing long-term support to the abdominal wall.