Skip to main content

Advertisement

SpringerLink
Log in

Preservation of deep epigastric perforators during anterior component separation technique (ACST) results in equivalent wound complications compared to transversus abdominis release (TAR)

  • Original Article
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Purpose

The use of component separation results in myofascial release and increased rates of fascial closure in abdominal wall reconstruction(AWR). These complex dissections have been associated with increased rates of wound complications with anterior component separation having the greatest wound morbidity. The aim of this paper was to compare the wound complication rate between perforator sparing anterior component separation(PS-ACST) and transversus abdominus release(TAR).

Methods

Patients were identified from a prospective, single institution hernia center database who underwent PS-ACST and TAR from 2015 to 2021. The primary outcome was wound complication rate. Standard statistical methods were used, univariate analysis and multivariable logistic regression were performed.

Results

A total of 172 patients met criteria, 39 had PS-ACST and 133 had TAR performed. The PS-ACST and TAR groups were similar in terms of diabetes (15.4% vs 28.6%, p = 0.097), but the PS-ACST group had a greater percentage of smokers (46.2% vs 14.3%, p < 0.001). The PS-ACST group had a larger hernia defect size (375.2 ± 156.7 vs 234.4 ± 126.9cm2, p < 0.001) and more patients who underwent preoperative Botulinum toxin A (BTA) injections (43.6% vs 6.0%, p < 0.001). The overall wound complication rate was not significantly different (23.1% vs 36.1%, p = 0.129) nor was the mesh infection rate (0% vs 1.6%, p = 0.438). Using logistic regression, none of the factors that were significantly different in the univariate analysis were associated with wound complication rate (all p > 0.05).

Conclusion

PS-ACST and TAR are comparable in terms of wound complication rates. PS-ACST can be used for large hernia defects and promote fascial closure with low overall wound morbidity and perioperative complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Poulose BK, Shelton J, Phillips S et al (2012) Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia 16:179–183. https://doi.org/10.1007/s10029-011-0879-9

    Article  CAS  PubMed  Google Scholar 

  2. Pauli EM, Rosen MJ (2013) Open ventral hernia repair with component separation. Surg Clin North Am 93:1111–1133

    Article  PubMed  Google Scholar 

  3. Fink C, Baumann P, Wente MN et al (2013) Incisional hernia rate 3 years after midline laparotomy. Brit J Surg. https://doi.org/10.1002/bjs.9364

    Article  PubMed  Google Scholar 

  4. Maloney SR, Schlosser KA, Prasad T et al (2019) Twelve years of component separation technique in abdominal wall reconstruction. Surgery (United States) 166:435–444

    Google Scholar 

  5. Holihan JL, Askenasy EP, Greenberg JA et al (2016) Component separation vs. bridged repair for large ventral hernias: a multi-institutional risk-adjusted comparison, systematic review, and meta-analysis. Surg Infect (Larchmt) 17:17–26. https://doi.org/10.1089/sur.2015.124

    Article  PubMed  Google Scholar 

  6. Giordano S, Garvey PB, Baumann DP et al (2017) Primary fascial closure with biologic mesh reinforcement results in lesser complication and recurrence rates than bridged biologic mesh repair for abdominal wall reconstruction: a propensity score analysis. Surgery (United States) 161:499–508

    Google Scholar 

  7. Ramirez OM, Ruas E, Dellon AL (1990) “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 86:519–526. https://doi.org/10.1097/00006534-199009000-00023

    Article  CAS  PubMed  Google Scholar 

  8. Kumar S, Edmunds RW, Dowdy C et al (2018) Anterior versus posterior component separation. Plast Reconstr Surg 142:47S-53S. https://doi.org/10.1097/PRS.0000000000004852

    Article  CAS  PubMed  Google Scholar 

  9. Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ (2012) Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg 204:709–716. https://doi.org/10.1016/j.amjsurg.2012.02.008

    Article  PubMed  Google Scholar 

  10. Majumder A, Martin-del-Campo LA, Miller HJ et al (2020) Evaluation of anterior versus posterior component separation for hernia repair in a cadaveric model. Surg Endosc 34:2682–2689. https://doi.org/10.1007/s00464-019-07046-9

    Article  PubMed  Google Scholar 

  11. Loh CYY, Nizamoglu M, Shanmugakrishnan RR et al (2018) Comparing transversus abdominus release and anterior component separation techniques in reconstructing midline hernias: a cadaveric study. J Plast Reconstr Aesthetic Surg 71:1507–1517

    Article  Google Scholar 

  12. Elhage SA, Marturano MN, Prasad T et al (2020) Impact of perforator sparing on anterior component separation outcomes in open abdominal wall reconstruction. Surg Endosc 1:3. https://doi.org/10.1007/s00464-020-07888-8

    Article  Google Scholar 

  13. Gonzalez R, Rehnke RD, Ramaswamy A et al (2005) Components separation technique and laparoscopic approach: a review of two evolving strategies for ventral hernia repair. Am Surg 71:598–605. https://doi.org/10.1177/000313480507100713

    Article  PubMed  Google Scholar 

  14. Katzen MM, Kercher KW, Sacco JM et al (2022) Open preperitoneal ventral hernia repair: prospective observagtional study of quality improvement outcomes over 18 years and 1842 patients. Surgery. https://doi.org/10.1016/j.surg.2022.07.042

    Article  PubMed  Google Scholar 

  15. Shao JM, Alimi Y, Conroy D, Bhanot P (2020) Outcomes using indocyanine green angiography with perforator-sparing component separation technique for abdominal wall reconstruction. Surg Endosc 34:2227–2236. https://doi.org/10.1007/s00464-019-07012-5

    Article  PubMed  Google Scholar 

  16. Clarke JM (2010) Incisional hernia repair by fascial component separation: results in 128 cases and evolution of technique. Am J Surg 200:2–8. https://doi.org/10.1016/j.amjsurg.2009.07.029

    Article  PubMed  Google Scholar 

  17. Ghali S, Turza KC, Baumann DP, Butler CE (2012) Minimally invasive component separation results in fewer wound-healing complications than open component separation for large ventral hernia repairs. J Am Coll Surg 214:981–989. https://doi.org/10.1016/j.jamcollsurg.2012.02.017

    Article  PubMed  PubMed Central  Google Scholar 

  18. Baucom RB, Ousley J, Feurer ID et al (2016) Patient reported outcomes after incisional hernia repair—establishing the ventral hernia recurrence inventory. Am J Surg 212:81–88. https://doi.org/10.1016/j.amjsurg.2015.06.007

    Article  PubMed  Google Scholar 

  19. Ayuso SA, Elhage SA, Aladegbami BG et al (2022) Delayed primary closure (DPC) of the skin and subcutaneous tissues following complex, contaminated abdominal wall reconstruction (AWR): a propensity-matched study. Surg Endosc 36:2169–2177. https://doi.org/10.1007/S00464-021-08485-Z

    Article  PubMed  Google Scholar 

  20. Heniford BT, Ross SW, Wormer BA et al (2020) Preperitoneal ventral hernia repair: a decade long prospective observational study with analysis of 1023 patient outcomes. Ann Surg 271:364–374. https://doi.org/10.1097/SLA.0000000000002966

    Article  PubMed  Google Scholar 

  21. Novitsky Y, Porter J, Rucho ZC et al (2006) Open preperitoneal retrofascial mesh repair for multiply recurrent ventral incisional hernias. J Am Coll Surg 203:283–289. https://doi.org/10.1016/J.JAMCOLLSURG.2006.05.297

    Article  PubMed  Google Scholar 

  22. Janis JE, Khansa I (2015) Evidence-based abdominal wall reconstruction: the maxi-mini approach. Plast Reconstr Surg 136:1312–1323. https://doi.org/10.1097/PRS.0000000000001831

    Article  CAS  PubMed  Google Scholar 

  23. Maloney SR, Schlosser KA, Prasad T et al (2020) The impact of component separation technique versus no component separation technique on complications and quality of life in the repair of large ventral hernias. Surg Endosc 34:981–987. https://doi.org/10.1007/s00464-019-06892-x

    Article  PubMed  Google Scholar 

  24. Ko JH, Wang EC, Salvay DM et al (2009) Abdominal wall reconstruction: lessons learned from 200 “components separation” procedures. Arch Surg 144:1047–1055. https://doi.org/10.1001/archsurg.2009.192

    Article  PubMed  Google Scholar 

  25. Butler CE (2018) Discussion. Plast Reconstr Surg 142:54S-55S. https://doi.org/10.1097/PRS.0000000000004854

    Article  CAS  PubMed  Google Scholar 

  26. Ayuso SA, Colavita PD, Augenstein VA et al (2022) Nationwide increase in component separation without concomitant rise in readmissions: a nationwide readmissions database analysis. Surgery 171:799–805. https://doi.org/10.1016/J.SURG.2021.09.012

    Article  PubMed  Google Scholar 

  27. Alkhatib H, Tastaldi L, Krpata DM et al (2019) Outcomes of transversus abdominis release (TAR) with permanent synthetic retromuscular reinforcement for bridged repairs in massive ventral hernias: a retrospective review. Hernia 24:341–352. https://doi.org/10.1007/S10029-019-02046-Z

    Article  PubMed  Google Scholar 

  28. Jones CM, Winder JS, Potochny JD, Pauli EM (2016) Posterior component separation with transversus abdominis release. Plast Reconstr Surg 137:636–646. https://doi.org/10.1097/01.prs.0000475778.45783.e2

    Article  CAS  PubMed  Google Scholar 

  29. Parent B, Horn D, Jacobson L et al (2017) Wound morbidity in minimally invasive anterior component separation compared to transversus abdominis release. Plast Reconstr Surg 139:472–479. https://doi.org/10.1097/PRS.0000000000002957

    Article  CAS  PubMed  Google Scholar 

  30. Krpata DM, Blatnik JA, Novitsky YW, Rosen MJ (2012) Midwest surgical association posterior and open anterior components separations: a comparative analysis. Am J Surg 203:318–322. https://doi.org/10.1016/j.amjsurg.2011.10.009

    Article  PubMed  Google Scholar 

  31. Walming S, Angenete E, Block M et al (2017) Retrospective review of risk factors for surgical wound dehiscence and incisional hernia. BMC Surg 17:1–6. https://doi.org/10.1186/s12893-017-0207-0

    Article  Google Scholar 

  32. Bueno-Lledó J, Franco-Bernal A, Garcia-Voz-Mediano T et al (2020) Prophylactic single-use negative pressure dressing in closed surgical wounds after incisional hernia repair a randomized, controlled trial. Ann Surg XX. https://doi.org/10.1097/SLA.0000000000004310

    Article  Google Scholar 

  33. Zwanenburg PR, Tol BT, Obdeijn MC et al (2020) Meta-analysis, meta-regression, and grade assessment of randomized and nonrandomized studies of incisional negative pressure wound therapy versus control dressings for the prevention of postoperative wound complications. Ann Surg 272:81–91. https://doi.org/10.1097/SLA.0000000000003644

    Article  PubMed  Google Scholar 

  34. Finan KR, Vick CC, Kiefe CI et al (2005) Predictors of wound infection in ventral hernia repair. Am J Surg 190:676–681. https://doi.org/10.1016/j.amjsurg.2005.06.041

    Article  PubMed  Google Scholar 

  35. Deerenberg EB, Elhage SA, Raible RJ, et al (2021) Image-guided botulinum toxin injection in the lateral abdominal wall prior to abdominal wall reconstruction surgery: review of techniques and results. Skelet Radiol 50:1-7

  36. Deerenberg EB, Shao JM, Elhage SA et al (2021) Preoperative botulinum toxin A injection in complex abdominal wall reconstruction– a propensity-scored matched study. Am J Surg 222:638–642. https://doi.org/10.1016/j.amjsurg.2021.01.010

    Article  PubMed  Google Scholar 

  37. Augenstein VA, Colavita PD, Wormer BA et al (2015) CeDAR: Carolinas equation for determining associated risks. J Am Coll Surg 221:S65–S66. https://doi.org/10.1016/j.jamcollsurg.2015.07.145

    Article  Google Scholar 

  38. Rosen MJ, Bauer JJ, Harmaty M et al (2017) Multicenter, prospective, longitudinal study of the recurrence, surgical site infection, and quality of life after contaminated ventral hernia repair using biosynthetic absorbable mesh: the COBRA study. Ann Surg 265:205–211. https://doi.org/10.1097/SLA.0000000000001601

    Article  PubMed  Google Scholar 

  39. Bababekov YJ, Stapleton SM, Mueller JL et al (2018) A proposal to mitigate the consequences of type 2 error in surgical science. Ann Surg 267:621–622. https://doi.org/10.1097/SLA.0000000000002547

    Article  PubMed  Google Scholar 

Download references

Funding

No funding was received to support this study.

Author information

Authors and Affiliations

  1. Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA

    S. A. Ayuso, M. J. Salvino, G. T. Scarola, D. Ku, R. Tawkaliyar, K. Brown, P. D. Colavita, K. W. Kercher, V. A. Augenstein & B. T. Heniford

  2. Department of Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA

    J. M. Sacco

Authors
  1. J. M. Sacco
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. A. Ayuso
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. J. Salvino
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G. T. Scarola
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. Ku
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R. Tawkaliyar
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. K. Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. P. D. Colavita
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. K. W. Kercher
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. V. A. Augenstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. B. T. Heniford
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. T. Heniford.

Ethics declarations

Conflict of interest

Dr. Heniford receives surgical research/education grants as well as honoraria for speaking from W.L. Gore and did so within the last 24 months from Allergan. Dr. Augenstein receives speaking honoraria from Medtronic, Allergan, Intuitive, Acelity, and Bard. Dr. Kercher received honoraria for speaking from Bard and Ethicon. The additional authors have nothing to disclose. No funding was received for this paper.

Ethical approval

Ethical approval was agreed by the ethical committee of the institution.

Human and animal rights

This study including human participants has been performed in accordance with the ethical standards of the Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was appropriately obtained for patients included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sacco, J., Ayuso, S.A., Salvino, M.J. et al. Preservation of deep epigastric perforators during anterior component separation technique (ACST) results in equivalent wound complications compared to transversus abdominis release (TAR). Hernia 27, 819–827 (2023). https://doi.org/10.1007/s10029-023-02811-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-023-02811-1

Keywords

Search

Navigation