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Lessons Learned From 200 "Components Separation" Procedures

Jason H. Ko, MD; Edward C. Wang, PhD; David M. Salvay, MS; Benjamin C. Paul, BA; Gregory A. Dumanian, MD

Arch Surg. 2009;144(11):1047-1055.

Objectives  To determine the efficacy and describe the evolution of the "components separation" technique for abdominal wall repair in 200 consecutive patients.

Design  Retrospective medical record review.

Setting  Northwestern Memorial Hospital, Chicago, Illinois.

Patients  Two hundred consecutive patients who underwent ventral hernia repair using the components separation technique.

Interventions  Biological and permanent meshes were used in select patients to augment the repair of the midline fascial closure but were not used as "bridging" materials.

Main Outcome Measures  Hernia recurrence rates and major and minor complication rates for the overall series and for the different techniques.

Results  Primary components separation (n = 158) yielded a 22.8% recurrence rate. Closure of the midline tissues with augmentation of the repair using an acellular cadaveric dermis underlay (n = 18) had a 33.3% recurrence rate requiring a second operation, whereas intra-abdominal soft polypropylene mesh (n = 18) had 0% recurrence (P = .04). Elevated body mass index was a significant risk factor predicting hernia recurrence (P = .003). Contamination (P = .04) and enterocutaneous fistula (P = .02) at the time of surgery were associated with increased major complications, whereas body mass index (P = .01) and diabetes mellitus (P = .04) were associated with increased minor complications.

Conclusions  Large complex hernias can be reliably repaired using the components separation technique despite the presence of open wounds, the need for bowel surgery, and numerous comorbidities. The long-term strength of the hernia repair is not augmented by acellular cadaveric dermis but seems to be improved with soft polypropylene mesh.

Author Affiliations: Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.

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