Abstract:

Objective

To evaluate the clinical efficacy of the component separation technique(CST) combined with complete extraperitoneal bridged mesh repair in the treatment of giant abdominal incisional hernia in adults, and to summarize the surgical procedure and technical details.

Methods

From January 2016 to June 2021, the clinical data of 36 patients with huge incisional hernia who were treated with CST combined with complete extraperitoneal bridging repair surgery in the Department of Hernia and Abdominal Wall Surgery, Wuhan Central Hospital, Tongji Medical College, Huazhong University of Science and Technology were retrospectively analyzed.The patients were followed up postoperatively.

Results

There were 36 patients in the research group, including 15 males and 21 females, aged 43-78 years, 8 cases of incisional hernia in the upper abdominal wall and 28 cases of incisional hernia in the lower abdominal wall; the average diameter of the hernia ring was (15.28±2.04) cm.All patients'operations were successfully completed.They resumed a liquid diet 12 hours after the operation, and got out of bed 24 hours after the operation.The postoperative defecation time of patients was 2-8 days, with an average of (3.8±1.7) days.3 patients had obvious abdominal distension symptoms in the early postoperative period, and symptomatic treatment was required with relief after 2 to 4 days.All patients complained of pain in the abdominal wall in the operation area within 48 hours after the operation.The visual analogue scale of pain (1-5 points) at 3 days after operation, with an average score of 2.6 points, 11 patients needed analgesics for adjuvant treatment for 2 to 10 days, with an average of (4.6±1.3) days.The postoperative hospital stay was 5 to 11 days, with an average of (6.8±1.6) days.The abdominal CT was reviewed 3 days after the operation and the abdominal cavity and wound drainage tube were removed.There was no obvious local hematoma that occurred, and the drainage volume in 72 hours was 200-710 ml,with an average of (260±30) ml.No local wound infection occurred in all patients at 7 d after operation,and 4 cases of fat liquefaction occurred.The postoperative follow-up period was 12 to 48 months.All patients were followed up, and there were no complications such as intestinal obstruction, delayed mesh infection, chronic pain, mesh bulge and recurrence of incisional hernia.

Conclusion

The CST combined with complete extraperitoneal bridged repair is a safe and effective surgical approach for treating giant abdominal incisional hernia in adults, and offers distinct advantages.

Key words: Incisional hernia, Complete extraperitoneal repair, Component separation technique, Hybrid technique, Abdominal wall hernia