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State-of-the-art abdominal wall reconstruction and closure

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Abstract

Open ventral hernia repair is one of the most common operations performed by general surgeons. Appropriate patient selection and preoperative optimization are important to ensure high-quality outcomes and prevent hernia recurrence. Preoperative adjuncts such as the injection of botulinum toxin and progressive preoperative pneumoperitoneum are proven to help achieve fascial closure in patients with hernia defects and/or loss of domain. Operatively, component separation techniques are performed on complex hernias in order to medialize the rectus fascia and achieve a tension-free closure. Other important principles of hernia repair include complete reduction of the hernia sac, wide mesh overlap, and techniques to control seroma and other wound complications. In the setting of contamination, a delayed primary closure of the skin and subcutaneous tissues should be considered to minimize the chance of postoperative wound complications. Ultimately, the aim for hernia surgeons is to mitigate complications and provide a durable repair while improving patient quality of life.

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Taken from Preperitoneal Ventral Hernia Repair: A Decade-Long Prospective Observational Study with Analysis of 1023 Patient Outcomes. Annals of Surgery. 2020. Content owned by the corresponding author

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The institutional data that the authors discuss in this manuscript is available upon written request to the corresponding author.

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Funding

Dr. Heniford receives research/education grants from Allergan and WL Gore. None of the other authors have disclosures to report.

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Authors and Affiliations

  1. Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA

    Sullivan A. Ayuso, Sharbel A. Elhage, Matthew J. Salvino & B. Todd Heniford

  2. Department of Surgery, University of FL Health–Jacksonville, Jacksonville, FL, USA

    Jana M. Sacco

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  1. Sullivan A. Ayuso
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  2. Sharbel A. Elhage
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Contributions

S.A.A., S.A.E., M.J.S., and B.T.H. were responsible for the organization and writing of the manuscript. All the authors reviewed the manuscript prior to publication.

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Correspondence to B. Todd Heniford.

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B Todd Heniford receives research/education grants from Allergan and WL Gore. None of the other authors have disclosures to report.

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Furtherreading

Heniford BT, Ross SW, Wormer BA, et al. Preperitoneal Ventral Hernia Repair: A decade long prospective observational study with analysis of 1023 patient outcomes. Annals of Surgery. 2020.

Katzen MM, Kercher KW, Sacco JM, et al. Open preperitoneal ventral hernia repair: prospective observational study of quality improvement outcomes over 18 years and 1,842 patients. Surgery. 2022.

Howard R, Delaney L, Kilbourne AM, et al. Development and implementation of preoperative optimization for high-risk patients with abdominal wall hernia. JAMA Open. 2021.

Liang MK, Bernardi K, Holihan JL, et al. Modifying risks in ventral hernia patients with prehabilitation: a randomized controlled trial. Annals of Surgery. 2021.

Dadashzadeh ER, Huckaby LV, Handzel R et al. The risk of incarceration during nonoperative management of incisional hernias: a population-based analysis of 30,998 patients. Annals of Surgery. 2022.

Deerenberg EB, Elhage SA, Shao JM, et al. The effects of preoperative Botulinum toxin A injection on abdominal wall reconstruction. Journal of Surgical Research. 2020.

Martínez-Hoed J, Bonafe-Diana S, Bueno-Lledó J. A systematic review of the use of progressive preoperative pneumoperitoneum since its inception. Hernia. 2021.

Elhage SA, Marturano MN, Deerenberg EB, et al. Impact of panniculectomy in complex abdominal wall reconstruction: a propensity-matched analysis in 624 patients.

Maloney SR, Schlosser KA, Prasad MA, et al. Twelve years of component separation technique in abdominal wall reconstruction. Surgery. 2019.

Novitsky YW, Elliott HL, Orenstein et al. Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. American Journal of Surgery. 2012.

Butler CE, Campbell KT. minimally invasive component separation with inlay bioprosthetic mesh (MICS) for complex abdominal wall reconstruction. Plastic and Reconstructive Surgery. 2011.

Deerenberg EB, Harlaar JJ, Steyerberg EW, et al. Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial. The Lancet. 2015.

Ayuso SA, Elhage SA, Aladegbami BG, et al. Delayed primary closure (DPC) of the skin and subcutaneous tissues following complex, contaminated abdominal wall reconstruction (AWR): a propensity-matched study. Surgical Endoscopy. 2021.

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Ayuso, S.A., Elhage, S.A., Salvino, M.J. et al. State-of-the-art abdominal wall reconstruction and closure. Langenbecks Arch Surg 408, 60 (2023). https://doi.org/10.1007/s00423-023-02811-w

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