Authors: Laurel J Blair Tiffany C Cox Ciara R Huntington Steven A Groene Tanushree Prasad Amy E Lincourt Kent W Kercher B Todd Heniford Vedra A Augenstein
Publish Date: 2016/12/30
Volume: 31, Issue: 9, Pages: 3539-3546
Abstract
Outcomes following OVHR may be affected by type of component separation In this study outcomes including QOL of patients undergoing OVHR were evaluated based on the utilization of transversus abdominis release TAR posterior rectus sheath release PRSR alone or in combination with external oblique release EOR + PRSRA prospective singleinstitution study following open ventral hernia repair involving component separation was performed from May 2005 to April 2015 Selfreported QOL outcomes were obtained preoperatively and at 1 6 and 12 months postoperatively using the Carolinas Comfort Scale CCS A CCS of 2 mild but bothersome discomfort or greater was considered symptomatic Comorbidities complications outcomes and CCS scores were reviewed Univariate group comparisons were performed using Chisquare and Wilcoxon twosample tests with statistical significance set at p 005During the study period 292 OVHRs with CST met inclusion criteria Singlesided different releases on opposite sides etc were eliminated Demographics included average age579 ± 119 years BMI340 ± 79 kgm2 532 female 69 at least one prior hernia repair and average defect size2912 ± 2362 cm2 Preoperative discomfort 82 vs 75 vs 79 p = 077 and movement limitation 94 vs 70 vs 78 p = 01 in TAR PRSR and EOR + PRSR were similar Average followup was 164 months At 1 6 and 12 months postoperatively there was no difference in reported CCS pain scores movement limitation or mesh sensation among the groups p 005 Comparing OVHR patients outcomes by CST type TAR was associated with decreased wound infections compared to others 32 vs 161 vs 20 p = 007 while recurrence rates were increased in EOR + PRSR compared to TAR and PRSR alone84 vs 3 vs 18 p = 003 Eighty percent of recurrences had a biologic mesh secondary to contaminated field during hernia repair The other two recurrences were one which occurred superior to the mesh at a suture site and one who developed a wound infection postoperatively Mesh infection rates were low 0 vs 15 vs 26 p 005 even including contaminated cases 0 vs 2 vs 36 p 005 and were statistically equivalent among all three techniquesWhile QOL is not impacted by type of component separation on short or longterm followup the TAR may provide benefits such as decreased wound infection rates Overall QOL had a significant improvement from preoperative regardless of type of component separation When controlling for field contamination there were no differences in recurrence or infectionDrs Heniford and Augenstein have previously been awarded surgical research and education grants from WL Gore and Associates Ethicon Novadaq Bard/Davol and LifeCell Inc All other authors have no conflicts of interest or financial ties to disclose
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