Anterior versus posterior component separation technique for advanced abdominal wall reconstruction: a proposed algorithm
Objective The precise indications for employing the anterior component separation technique (ACST) and the Transversus Abdominis Release (TAR) in abdominal wall reconstruction (AWR) remain uncertain, despite the undeniable value of both techniques. The aim of this study was to analyze the anterior f...
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| Veröffentlicht in: | Hernia : the journal of hernias and abdominal wall surgery 2024-06, Vol.28 (3), p.895-904 |
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| creator | Dries, P. Verstraete, B. Allaeys, M. Van Hoef, S. Eker, H. Berrevoet, F. |
| description | Objective
The precise indications for employing the anterior component separation technique (ACST) and the Transversus Abdominis Release (TAR) in abdominal wall reconstruction (AWR) remain uncertain, despite the undeniable value of both techniques. The aim of this study was to analyze the anterior fascial closure rate, postoperative wound morbidity, and hernia recurrence rate for both procedures according to the algorithm used for complex AWR.
Methods
A retrospective analysis of prospectively collected data was carried out. Patients undergoing AWR for midline incisional hernias using either open or endoscopic ACST (E-ACST) or TAR between March 2013 and August 2022 were included. Patients with lateral hernia components were excluded. The surgical technique was depending on the pre- and intraoperative findings regarding hernia width and on the estimated traction to achieve anterior fascial closure (see algorithm). Initially, intermediate hernia defects ranging from approximately 10–14 cm in width were repaired using E-ACST. However, as the study advanced, TAR became the preferred method for addressing these types of defects. Open ACST was consistently employed for defects wider than 14–15 cm throughout the entire study duration. Outcomes of interest were anterior fascial closure, surgical site occurrences, and hernia recurrence rate. Follow-up was performed at 1 month, 1 year, and 2 years.
Results
A total of 119 patients underwent AWR with CST: 63 patients (52.9%) were included in the ACST group and 56 patients (47.1%) in the TAR group. No significant differences were observed in patient and hernia characteristics. The use of botulinum toxin A (BTA) injection and preoperative progressive pneumoperitoneum (PPP) was more frequently used in the ACST group (BTA 19.0%, PPP 15.9% versus BTA 5.4%, PPP 1.8% for TAR patients). Anterior fascial closure was achieved in 95.2% of the ACST group and 98.2% of the TAR group (
p
= 0.369). The TAR group demonstrated a significantly lower SSO rate at one month (44.3% versus 14.3%,
p
|
| doi_str_mv | 10.1007/s10029-024-03039-3 |
| format | Article |
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The precise indications for employing the anterior component separation technique (ACST) and the Transversus Abdominis Release (TAR) in abdominal wall reconstruction (AWR) remain uncertain, despite the undeniable value of both techniques. The aim of this study was to analyze the anterior fascial closure rate, postoperative wound morbidity, and hernia recurrence rate for both procedures according to the algorithm used for complex AWR.
Methods
A retrospective analysis of prospectively collected data was carried out. Patients undergoing AWR for midline incisional hernias using either open or endoscopic ACST (E-ACST) or TAR between March 2013 and August 2022 were included. Patients with lateral hernia components were excluded. The surgical technique was depending on the pre- and intraoperative findings regarding hernia width and on the estimated traction to achieve anterior fascial closure (see algorithm). Initially, intermediate hernia defects ranging from approximately 10–14 cm in width were repaired using E-ACST. However, as the study advanced, TAR became the preferred method for addressing these types of defects. Open ACST was consistently employed for defects wider than 14–15 cm throughout the entire study duration. Outcomes of interest were anterior fascial closure, surgical site occurrences, and hernia recurrence rate. Follow-up was performed at 1 month, 1 year, and 2 years.
Results
A total of 119 patients underwent AWR with CST: 63 patients (52.9%) were included in the ACST group and 56 patients (47.1%) in the TAR group. No significant differences were observed in patient and hernia characteristics. The use of botulinum toxin A (BTA) injection and preoperative progressive pneumoperitoneum (PPP) was more frequently used in the ACST group (BTA 19.0%, PPP 15.9% versus BTA 5.4%, PPP 1.8% for TAR patients). Anterior fascial closure was achieved in 95.2% of the ACST group and 98.2% of the TAR group (
p
= 0.369). The TAR group demonstrated a significantly lower SSO rate at one month (44.3% versus 14.3%,
p
< 0.001) and required fewer procedural interventions (SSO-PI) (31.1% versus 8.9%,
p
= 0.003). The recurrence rate at one year was low and there was no statistically significant difference between the two groups (ACST 1.8% vs TAR 4.5%,
p
= 0.422).
Conclusion
Following a proposed algorithm, the anterior fascial closure rate was high and similar for both techniques. As postoperative wound morbidity is significantly increased after ACST, our findings support recommending TAR for defects up to 14 cm in width, while favoring open ACST for larger defects.</description><identifier>ISSN: 1248-9204</identifier><identifier>ISSN: 1265-4906</identifier><identifier>EISSN: 1248-9204</identifier><identifier>DOI: 10.1007/s10029-024-03039-3</identifier><identifier>PMID: 38652204</identifier><language>eng</language><publisher>Paris: Springer Paris</publisher><subject>Abdominal Surgery ; Abdominal wall ; Algorithms ; Botulinum toxin type A ; Complex Incisional Hernia ; Hernia ; Hernias ; Medicine ; Medicine & Public Health ; Morbidity ; Original Article ; Reconstructive surgery ; Statistical analysis ; Wound healing</subject><ispartof>Hernia : the journal of hernias and abdominal wall surgery, 2024-06, Vol.28 (3), p.895-904</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature 2024. 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.</rights><rights>2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-d0d03440a6aa7f05af3bea451ec3fb11d1a53fa7a8f4f8980845b497845609a93</citedby><cites>FETCH-LOGICAL-c375t-d0d03440a6aa7f05af3bea451ec3fb11d1a53fa7a8f4f8980845b497845609a93</cites><orcidid>0000-0002-9764-6902 ; 0000-0002-1932-8175 ; 0000-0002-3575-5345 ; 0009-0000-6943-1384 ; 0000-0002-8712-8749</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10029-024-03039-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10029-024-03039-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38652204$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dries, P.</creatorcontrib><creatorcontrib>Verstraete, B.</creatorcontrib><creatorcontrib>Allaeys, M.</creatorcontrib><creatorcontrib>Van Hoef, S.</creatorcontrib><creatorcontrib>Eker, H.</creatorcontrib><creatorcontrib>Berrevoet, F.</creatorcontrib><title>Anterior versus posterior component separation technique for advanced abdominal wall reconstruction: a proposed algorithm</title><title>Hernia : the journal of hernias and abdominal wall surgery</title><addtitle>Hernia</addtitle><addtitle>Hernia</addtitle><description>Objective
The precise indications for employing the anterior component separation technique (ACST) and the Transversus Abdominis Release (TAR) in abdominal wall reconstruction (AWR) remain uncertain, despite the undeniable value of both techniques. The aim of this study was to analyze the anterior fascial closure rate, postoperative wound morbidity, and hernia recurrence rate for both procedures according to the algorithm used for complex AWR.
Methods
A retrospective analysis of prospectively collected data was carried out. Patients undergoing AWR for midline incisional hernias using either open or endoscopic ACST (E-ACST) or TAR between March 2013 and August 2022 were included. Patients with lateral hernia components were excluded. The surgical technique was depending on the pre- and intraoperative findings regarding hernia width and on the estimated traction to achieve anterior fascial closure (see algorithm). Initially, intermediate hernia defects ranging from approximately 10–14 cm in width were repaired using E-ACST. However, as the study advanced, TAR became the preferred method for addressing these types of defects. Open ACST was consistently employed for defects wider than 14–15 cm throughout the entire study duration. Outcomes of interest were anterior fascial closure, surgical site occurrences, and hernia recurrence rate. Follow-up was performed at 1 month, 1 year, and 2 years.
Results
A total of 119 patients underwent AWR with CST: 63 patients (52.9%) were included in the ACST group and 56 patients (47.1%) in the TAR group. No significant differences were observed in patient and hernia characteristics. The use of botulinum toxin A (BTA) injection and preoperative progressive pneumoperitoneum (PPP) was more frequently used in the ACST group (BTA 19.0%, PPP 15.9% versus BTA 5.4%, PPP 1.8% for TAR patients). Anterior fascial closure was achieved in 95.2% of the ACST group and 98.2% of the TAR group (
p
= 0.369). The TAR group demonstrated a significantly lower SSO rate at one month (44.3% versus 14.3%,
p
< 0.001) and required fewer procedural interventions (SSO-PI) (31.1% versus 8.9%,
p
= 0.003). The recurrence rate at one year was low and there was no statistically significant difference between the two groups (ACST 1.8% vs TAR 4.5%,
p
= 0.422).
Conclusion
Following a proposed algorithm, the anterior fascial closure rate was high and similar for both techniques. As postoperative wound morbidity is significantly increased after ACST, our findings support recommending TAR for defects up to 14 cm in width, while favoring open ACST for larger defects.</description><subject>Abdominal Surgery</subject><subject>Abdominal wall</subject><subject>Algorithms</subject><subject>Botulinum toxin type A</subject><subject>Complex Incisional Hernia</subject><subject>Hernia</subject><subject>Hernias</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Morbidity</subject><subject>Original Article</subject><subject>Reconstructive surgery</subject><subject>Statistical analysis</subject><subject>Wound healing</subject><issn>1248-9204</issn><issn>1265-4906</issn><issn>1248-9204</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp9kUFP3DAQha2qFSxb_gCHylIvvYSOYydxekMrCkgrcaFna-LYu0GJndoJaP89XnZLqx64eKzx955n9Ai5YHDJAKrvMZ15nUEuMuDA64x_IAuWC5nVOYiP_9xPyVmMjwAgRSlPyCmXZZGn_oLsrtxkQucDfTIhzpGOPh4b2g-jd8ZNNJoRA06dd3Qyeuu637OhNiHYPqHTpqXYtH7oHPb0GfueBqO9i1OY9V70gyIdg0_Oe7Lf-NBN2-Ez-WSxj-b8WJfk18_rh9Vttr6_uVtdrTPNq2LKWmiBCwFYIlYWCrS8MSgKZjS3DWMtw4JbrFBaYWUt04pFI-oqlRJqrPmSfDv4phHS3HFSQxe16Xt0xs9RcUhmrJRMJvTrf-ijn0Paak9JqKHIS5Go_EDp4GMMxqoxdAOGnWKg9sGoQzAqBaNeg1E8ib4credmMO2b5E8SCeAHIKYntzHh79_v2L4Ab72bEQ</recordid><startdate>20240601</startdate><enddate>20240601</enddate><creator>Dries, P.</creator><creator>Verstraete, B.</creator><creator>Allaeys, M.</creator><creator>Van Hoef, S.</creator><creator>Eker, H.</creator><creator>Berrevoet, F.</creator><general>Springer Paris</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9764-6902</orcidid><orcidid>https://orcid.org/0000-0002-1932-8175</orcidid><orcidid>https://orcid.org/0000-0002-3575-5345</orcidid><orcidid>https://orcid.org/0009-0000-6943-1384</orcidid><orcidid>https://orcid.org/0000-0002-8712-8749</orcidid></search><sort><creationdate>20240601</creationdate><title>Anterior versus posterior component separation technique for advanced abdominal wall reconstruction: a proposed algorithm</title><author>Dries, P. ; Verstraete, B. ; Allaeys, M. ; Van Hoef, S. ; Eker, H. ; Berrevoet, F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-d0d03440a6aa7f05af3bea451ec3fb11d1a53fa7a8f4f8980845b497845609a93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Abdominal Surgery</topic><topic>Abdominal wall</topic><topic>Algorithms</topic><topic>Botulinum toxin type A</topic><topic>Complex Incisional Hernia</topic><topic>Hernia</topic><topic>Hernias</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Morbidity</topic><topic>Original Article</topic><topic>Reconstructive surgery</topic><topic>Statistical analysis</topic><topic>Wound healing</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dries, P.</creatorcontrib><creatorcontrib>Verstraete, B.</creatorcontrib><creatorcontrib>Allaeys, M.</creatorcontrib><creatorcontrib>Van Hoef, S.</creatorcontrib><creatorcontrib>Eker, H.</creatorcontrib><creatorcontrib>Berrevoet, F.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Hernia : the journal of hernias and abdominal wall surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dries, P.</au><au>Verstraete, B.</au><au>Allaeys, M.</au><au>Van Hoef, S.</au><au>Eker, H.</au><au>Berrevoet, F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Anterior versus posterior component separation technique for advanced abdominal wall reconstruction: a proposed algorithm</atitle><jtitle>Hernia : the journal of hernias and abdominal wall surgery</jtitle><stitle>Hernia</stitle><addtitle>Hernia</addtitle><date>2024-06-01</date><risdate>2024</risdate><volume>28</volume><issue>3</issue><spage>895</spage><epage>904</epage><pages>895-904</pages><issn>1248-9204</issn><issn>1265-4906</issn><eissn>1248-9204</eissn><abstract>Objective
The precise indications for employing the anterior component separation technique (ACST) and the Transversus Abdominis Release (TAR) in abdominal wall reconstruction (AWR) remain uncertain, despite the undeniable value of both techniques. The aim of this study was to analyze the anterior fascial closure rate, postoperative wound morbidity, and hernia recurrence rate for both procedures according to the algorithm used for complex AWR.
Methods
A retrospective analysis of prospectively collected data was carried out. Patients undergoing AWR for midline incisional hernias using either open or endoscopic ACST (E-ACST) or TAR between March 2013 and August 2022 were included. Patients with lateral hernia components were excluded. The surgical technique was depending on the pre- and intraoperative findings regarding hernia width and on the estimated traction to achieve anterior fascial closure (see algorithm). Initially, intermediate hernia defects ranging from approximately 10–14 cm in width were repaired using E-ACST. However, as the study advanced, TAR became the preferred method for addressing these types of defects. Open ACST was consistently employed for defects wider than 14–15 cm throughout the entire study duration. Outcomes of interest were anterior fascial closure, surgical site occurrences, and hernia recurrence rate. Follow-up was performed at 1 month, 1 year, and 2 years.
Results
A total of 119 patients underwent AWR with CST: 63 patients (52.9%) were included in the ACST group and 56 patients (47.1%) in the TAR group. No significant differences were observed in patient and hernia characteristics. The use of botulinum toxin A (BTA) injection and preoperative progressive pneumoperitoneum (PPP) was more frequently used in the ACST group (BTA 19.0%, PPP 15.9% versus BTA 5.4%, PPP 1.8% for TAR patients). Anterior fascial closure was achieved in 95.2% of the ACST group and 98.2% of the TAR group (
p
= 0.369). The TAR group demonstrated a significantly lower SSO rate at one month (44.3% versus 14.3%,
p
< 0.001) and required fewer procedural interventions (SSO-PI) (31.1% versus 8.9%,
p
= 0.003). The recurrence rate at one year was low and there was no statistically significant difference between the two groups (ACST 1.8% vs TAR 4.5%,
p
= 0.422).
Conclusion
Following a proposed algorithm, the anterior fascial closure rate was high and similar for both techniques. As postoperative wound morbidity is significantly increased after ACST, our findings support recommending TAR for defects up to 14 cm in width, while favoring open ACST for larger defects.</abstract><cop>Paris</cop><pub>Springer Paris</pub><pmid>38652204</pmid><doi>10.1007/s10029-024-03039-3</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-9764-6902</orcidid><orcidid>https://orcid.org/0000-0002-1932-8175</orcidid><orcidid>https://orcid.org/0000-0002-3575-5345</orcidid><orcidid>https://orcid.org/0009-0000-6943-1384</orcidid><orcidid>https://orcid.org/0000-0002-8712-8749</orcidid></addata></record> |
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| subjects | Abdominal Surgery Abdominal wall Algorithms Botulinum toxin type A Complex Incisional Hernia Hernia Hernias Medicine Medicine & Public Health Morbidity Original Article Reconstructive surgery Statistical analysis Wound healing |
| title | Anterior versus posterior component separation technique for advanced abdominal wall reconstruction: a proposed algorithm |
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