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P044: THE CORSET REPAIR: A NOVEL TECHNIQUE FOR VENTRAL ABDOMINAL HERNIAS
Omar Elfanagely, MD; Yasmeen Byrnes, BA; Yoshiko Toyoda, MD; Sammy Othman, BS; John P Fischer, MD, MPH; Robyn B Broach, PhD; University of Pennsylvania
Introduction: Large and complex defects of the anterior abdominal wall often occur following previous surgery. The management of such defects posses a challenge, in part due to the high hernia recurrence rate. Component separation provides a tension-free autologous muscular closure by helping to advance the fascia and access privilege abdominal wall planes. The corset repair is a novel technique that capitalizes on these benefits offering a promising and potentially more durable fascial closure. We herein aim to conduct a retrospective review of a surgeon's experience and patient outcomes following this repair technique.
Method: All patients who underwent a Corset hernia repair with Poly-4-hydroxybutyric acid (P4HB, Phasix®) mesh by a single plastic and reconstructive surgeon between December 2016 and November 2019 were identified. The primary outcome measured was hernia recurrence rate. Secondary outcomes included post-operative complications. Patient demographic, and clinical and operative characteristic were analyzed using descriptive statistics. The corset repair is an anterior midline technique that requires bilateral release of both external oblique aponeurosis and muscle, followed by placement of an onlay biosynthetic mesh, and finally medial mobilization of the muscle and soft tissue flaps.
Results: A total of 33 patients underwent corset repair, nine of which had greater than 1 year follow up. Mean patient age was 54.5 years (range, 23– 74). Median defect size was 408 cm2 (Interquartile range +/- 292cm2). The majority of patients were female (82%), non-smokers (56%), non-diabetic (85%), and had an ASA of class 3 (66%). The most common preoperative wound class was 1 (66%). The median follow-up period was 4.4 months (IQR +/- 9.5 months). The index incisional hernia was most commonly due to an abdominal flap donor site (n=10), followed by a general surgery procedure (n=6), gynecologic procedure (n=5), emergent/trauma exploratory laparotomy (n=4), bariatric procedure (n=3), colorectal procedure (n=2) and last a urologic procedure (n=1). A concurrent procedure was performed on 60% of the population, in addition to the hernia repair. The median length of the operation was 315 minutes (IQR +/- 161). Overall, surgical site infection, seroma, and hematoma rate observed was 12%, 3%, and 18% respectively. In patients with at least 1 year of follow up the hernia rate was 0%. We did not observe an infected mesh. Patients developed deep venous thrombosis at a rate of 12%.
Conclusion: The Corset repair is a safe and effective method because of its ability to regain lost domain space, release tension, and leverage the lamellar structures of the abdominal wall to close large defects. Because of this it is our preferred method for tension-free hernia repair in complex situations.
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