To investigate the method and efficacy of artificial anti-adhesion composite mesh combined with component separation technique for repairing huge abdominal wall defects after abdominal wall tumor resection.

A retrospective analysis was conducted on the clinical data of 12 patients who underwent treatment and repair of large abdominal wall defects after resection of abdominal wall tumors or giant abdominal wall tumors in the Department of Gastroentero-pancreatic, Hernia and Abdominal Wall Surgery, Shanxi Provincial People's Hospital from February 2020 to July 2022. All the 12 cases met the criteria of type Ⅲ abdominal wall defect classification. The defect centers of 5 cases were located in the M1-M3 area, 1 case in the M4 area, 3 cases in the U area, and 3 cases in the L area. The lower edge of M4 and L area mesh was fixed to Cooper's ligament, the upper edge of U area mesh was fixed to the intercostal space, and the opposite side was inserted into the retromuscular space. After separation of subcutaneous tissue, the primary suture was performed. The mesh exceeded the margin of the defect by at least 5 cm. For huge abdominal wall tumors that could not be closed after resection, mesh was used to bridge the abdominal wall. After the repair was completed, a negative pressure drainage tube was routinely placed at a low position in front of the patch. After operation, the drainage tube was continuously suctioned with negative pressure, and the abdominal wall was bandaged with abdominal band pressure. All patients were followed up.

R0 resection of abdominal wall tumors was achieved in all 12 patients. The amount of drainage fluid for 24 hours after surgery was 60~210 ml, with an average of 130 ml. The indication of drainage tube removal was that the drainage volume was less than 10 ml for 24 hours on 3 consecutive days, and the extubation time was 12-35 days after surgery, with an average of 21.3 days. Subcutaneous effusion and seroma occurred in 3 cases after extubation, which were cured by local catheter drainage and pressure bandaging after puncture and aspiration. Postoperative abdominal wall pain occurred in 2 cases, and the pain symptoms disappeared after symptomatic treatment. One case of pulmonary infection and one case of incision infection were cured after treatment with antibiotics, dressing changes, oxidation atomization, back patting, and sputum. One case of incomplete intestinal obstruction was cured by an enema with warm soapy water and bedside activities. No cases of abdominal compartment syndrome occurred after operation. All patients were followed up from 4 months to 2 years after discharge. During follow-up, 1 patient had local tumor recurrence, and the rest did not have an abdominal incisional hernia or an adhesive ileus.

The application of composite mesh combined with component separation technology, using the retromuscular preperitoneal space to reliably fix the edge area of mesh to repair the large abdominal wall defect after tumor resection, is an effective, reliable and safe surgical method, can effectively prevent the abdominal wall incisional hernia, adhesive intestinal obstruction and other complications.