Hernia Research Today is a free monthly online journal that collates and summarizes the latest research about Hernia, including details on hiatal, inguinal, umbilical, abdominal, treatment.

Components separation combined with abdominal wall plication for repair of large abdominal wall hernias following bariatric surgery.

Borud LJ, Grunwaldt L, Janz B, Mun E, Slavin SA

Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA. lborud@bidmc.harvard.edu

BACKGROUND: Abdominal wall hernias frequently occur after open bariatric surgical procedures. Standard repair with synthetic mesh may be suboptimal, with a recurrence rate as high as 50 percent. Patients often seek hernia repair in conjunction with abdominal body contouring procedures following substantial weight loss. METHODS: In 66 consecutive patients undergoing abdominal surgery after open bariatric surgery, abdominal wall hernias of some size were found in 50 patients. In 65 of these patients, panniculectomy was performed simultaneously. The majority of these hernias could be closed primarily in conjunction with abdominal wall plication [38 of 50 (76 percent)]. In 12 patients (24 percent of hernias), the defects were too large (median, 10.8 cm) or located too close to the xiphoid to permit primary closure without undue tension. RESULTS: Using a components separation technique, primary fascial closure was achieved in all 12 patients. The technique was modified to include abdominal wall plication above and below the repaired hernia defect and the use of an absorbable mesh onlay. Although these patients had a high rate (50 percent) of minor or major superficial wound complications, all wounds closed subsequently without additional operative procedures. Despite the high-risk nature of this group, ventral hernia recurred in only one of 12 patients (8.3 percent) after a median follow-up of 16 months. The single recurrence occurred in one of the two patients with the largest diameter (15 cm) hernias in the series. CONCLUSIONS: The components separation technique combined with abdominal wall plication was assessed as the preferred technique for the repair of large hernias not amenable to primary repair in the massive weight loss patient following open bariatric procedures. Because this technique avoids placement of permanent mesh, it is particularly advantageous in the post-bariatric surgery patient at high risk for wound dehiscence and infection.

Published 18 April 2007 in Plast Reconstr Surg, 119(6): 1792-8.
Full-text of this article is available online (may require subscription).

© 2004-2008 Hernia Research Today. All Rights Reserved.