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P005: COMPLEX VENTRAL HERNIA REPAIR WITH COMPONENT SEPARATION IN HIGH RISK PATIENT POPULATION: CLASSIC SURGICAL TEACHINGS HOLD TRUE
Jordan N Halsey, MD1; Frank S Ciminello, MD2; Sebastian R Eid, MD2; 1Rutgers-New Jersey Medical School; 2Hackensack University Medical Center
Purpose: Reconstructive techniques in complex abdominal wall reconstruction have evolved throughout the past decade. Improvements in mesh technology, along with the utilization of component separation have allowed for the repair of massive hernia defects in complex patients with significant comorbidities. Notably, this procedure is often combined with panniculectomy.
Methods: We performed a retrospective review on all patients who underwent a complex ventral hernia repair with component separation with or without panniculectomy from 2015 to 2019 at Hackensack University Medical Center in Hackensack, NJ. Demographic data was obtained from medical records, including patient medical history, smoking status, and comorbidities, along with any prior hernia surgery.
Results: A total of 40 patients met inclusion criteria for our study, 27 females and 13 males. Every patient had at least one medical comorbidity. There were three active smokers and 13 former smokers. Hernia size ranged from 40 sq. cm to 400 sq. cm and component separation, either anterior or posterior, was performed on all patients. Mesh was included in 90% of cases, most commonly in a retrorectus position. Five patients had complications, including hematoma, late recurrence, pulmonary embolism, and closed-loop bowel obstruction. There were thirteen patients with minor surgical site occurrences that resolved with local wound care. Concomitant panniculectomy, obesity, and higher ASA class were associated with a higher complication rate.
Conclusion: Complex hernia repair with component separation can be performed in high-risk patients safely with an acceptable outcome. This can be performed with panniculectomy with a potential increased risk for complications.
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