To explore the feasibility and effectiveness of bridging technique in repairing complex abdominal wall defect.

The clinical data of 73 patients with complex abdominal wall defect who underwent bridging repair surgery were retrospectively collected. These patients were admitted by the same surgical team from Huadong Hospital Affiliated to Fudan University and the Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine between January 2016 and December 2024. A retrospective case-control study was conducted. According to the different surgical procedures, they were divided into three groups: the single-layer bridging group (single mesh bridging repair, n=23), double-layer bridging group (double-mesh bridging repair, n=21) and BOSS bridging group [biological-omentum-synthetic sandwich (BOSS) bridging repair, n=29]. The data of postoperative drainage days, average drainage volume 7 days after surgery, postoperative hospital stay, postoperative abdominal wall hernia recurrence/bulging rate and the incidence of incision complications in three groups of patients were analyzed.

All patients met the surgical indications and completed the operation successfully. The average length×width of abdominal wall defects for patients in the single-layer bridging group, double-layer bridging group and BOSS bridging group were (16.6±6.0) cm× (13.3±4.3) cm, (13.8±3.8) cm×(10.9±3.3) cm and (20.9±7.7) cm×(13.6±5.4) cm. The mean time of drainage tube was (18.7±8.2) days, (14.5±6.1) days and (15.6±6.4) days, respectively, and the difference was not statistically significant (P=0.111). The average drainage volume 7 days after surgery was (169.0±105.7) ml, (108.4±45.4) ml and (164.8±76.5) ml, respectively, and the difference was statistically significant (P=0.023). The average hospital stay was (26.2±19.7) days, (15.1±10.2) days, and (21.2±8.9) days, respectively, and the difference was statistically significant (P=0.010). The mean follow-up period was (54.0±23.6) months. The recurrence/bulging rate of abdominal wall hernia was 87.0%, 23.8% and 6.9% in the single-layer bridging group, double-layer bridging group and BOSS bridging group, respectively, with statistically significant differences (χ²=37.427, P<0.001). The incidence of incision complications was 43.5%, 19.0% and 17.2%, respectively, with statistically significant differences (χ²=4.282, P=0.028).

BOSS bridging technique can significantly reduce the postoperative recurrence rate and the incidence of incisional complications. This technique provides a new solution for bridging repair of complex abdominal wall defects.