H Alkhatib1, L Tastaldi2, D M Krpata2, C C Petro2, M Olson3, S Rosenblatt2, M J Rosen2, A S Prabhu2. 1. Comprehensive Hernia Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA. alkhath2@ccf.org. 2. Comprehensive Hernia Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA. 3. Department of Biostatistics, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA.
Abstract
PURPOSE: Elective repair of large incisional hernias using posterior component separation with transversus abdominis release (TAR) has acceptable wound morbidity and long-term recurrence rates. The outcomes of using this reconstructive technique in the non-elective setting remains unknown. We aim to report 30-day outcomes of TAR in non-elective settings. METHODS: All patients undergoing open TAR in non-elective settings were identified within the Americas Hernia Society Quality Collaborative (AHSQC). A retrospective review was conducted and outcomes of interest were 30-day Surgical Site Infections (SSI), Surgical Site Occurrences (SSO), SSOs requiring procedural intervention (SSOPI), medical complications, and unplanned readmissions and reoperations. RESULTS: Fifty-nine patients met inclusion criteria. Mean BMI was 36.6 ± 8.9 kg/m2 and mean hernia width was 14.4 ± 7.2 cm. Forty (67.8%) were recurrent hernias. Pain (88%) and bowel obstruction (79.7%) were the most frequent indications for surgery. Surgical field was classified as clean in 69.5% of cases, with an 88% use of permanent synthetic mesh and fascial closure achieved in 93.2% of cases. There were 15 (25.4%) total wound events, 8 (13.6%) were SSIs. There were 8 (13.6%) SSOPIs, 6 of which were wound opening, 1 wound debridement, and 1 percutaneous drainage. At least one wound or medical complication was reported for 37% of the patients. There were no mortalities. CONCLUSION: Not surprisingly, TAR in the non-elective setting is associated with increased wound morbidity requiring procedural interventions and reoperations compared to what has previously been reported for elective cases. The long-term consequences of this wound morbidity with regard to hernia recurrence are as of yet unknown.
PURPOSE: Elective repair of large incisional hernias using posterior component separation with transversus abdominis release (TAR) has acceptable wound morbidity and long-term recurrence rates. The outcomes of using this reconstructive technique in the non-elective setting remains unknown. We aim to report 30-day outcomes of TAR in non-elective settings. METHODS: All patients undergoing open TAR in non-elective settings were identified within the Americas Hernia Society Quality Collaborative (AHSQC). A retrospective review was conducted and outcomes of interest were 30-day Surgical Site Infections (SSI), Surgical Site Occurrences (SSO), SSOs requiring procedural intervention (SSOPI), medical complications, and unplanned readmissions and reoperations. RESULTS: Fifty-nine patients met inclusion criteria. Mean BMI was 36.6 ± 8.9 kg/m2 and mean hernia width was 14.4 ± 7.2 cm. Forty (67.8%) were recurrent hernias. Pain (88%) and bowel obstruction (79.7%) were the most frequent indications for surgery. Surgical field was classified as clean in 69.5% of cases, with an 88% use of permanent synthetic mesh and fascial closure achieved in 93.2% of cases. There were 15 (25.4%) total wound events, 8 (13.6%) were SSIs. There were 8 (13.6%) SSOPIs, 6 of which were wound opening, 1 wound debridement, and 1 percutaneous drainage. At least one wound or medical complication was reported for 37% of the patients. There were no mortalities. CONCLUSION: Not surprisingly, TAR in the non-elective setting is associated with increased wound morbidity requiring procedural interventions and reoperations compared to what has previously been reported for elective cases. The long-term consequences of this wound morbidity with regard to hernia recurrence are as of yet unknown.
Authors: Laura K Altom; Christopher W Snyder; Stephen H Gray; Laura A Graham; Catherine C Vick; Mary T Hawn Journal: Am Surg Date: 2011-08 Impact factor: 0.688
Authors: Krislynn M Mueck; Julie L Holihan; Jiandi Mo; Juan R Flores-Gonzales; Tien C Ko; Lillian S Kao; Mike K Liang Journal: Am J Surg Date: 2016-09-30 Impact factor: 2.565
Authors: Mike K Liang; Julie L Holihan; Kamal Itani; Zeinab M Alawadi; Juan R Flores Gonzalez; Erik P Askenasy; Conrad Ballecer; Hui Sen Chong; Matthew I Goldblatt; Jacob A Greenberg; John A Harvin; Jerrod N Keith; Robert G Martindale; Sean Orenstein; Bryan Richmond; John Scott Roth; Paul Szotek; Shirin Towfigh; Shawn Tsuda; Khashayar Vaziri; David H Berger Journal: Ann Surg Date: 2017-01 Impact factor: 12.969
Authors: Clayton C Petro; Sean B Orenstein; Cory N Criss; Edmund Q Sanchez; Michael J Rosen; Kenneth J Woodside; Yuri W Novitsky Journal: Am J Surg Date: 2015-01-26 Impact factor: 2.565
Authors: Karl Breuing; Charles E Butler; Stephen Ferzoco; Michael Franz; Charles S Hultman; Joshua F Kilbridge; Michael Rosen; Ronald P Silverman; Daniel Vargo Journal: Surgery Date: 2010-03-20 Impact factor: 3.982
Authors: B K Poulose; S Roll; J W Murphy; B D Matthews; B Todd Heniford; G Voeller; W W Hope; M I Goldblatt; G L Adrales; M J Rosen Journal: Hernia Date: 2016-03-02 Impact factor: 4.739
Authors: A N Christopher; M P Morris; V Patel; J A Mellia; C Fowler; C A Messa; R B Broach; J P Fischer Journal: Hernia Date: 2021-04-27 Impact factor: 4.739
Authors: C Stabilini; B East; R Fortelny; J-F Gillion; R Lorenz; A Montgomery; S Morales-Conde; F Muysoms; M Pawlak; W Reinpold; M Simons; A C de Beaux Journal: Hernia Date: 2020-05-15 Impact factor: 4.739