• J. Am. Coll. Surg. · Sep 2019

    Comparative Study

    Surgical Outcomes in Lateral Abdominal Wall Reconstruction: A Comparative Analysis of Surgical Techniques.

    • Sahil K Kapur, Jun Liu, Donald P Baumann, and Charles E Butler.
    • Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: skkapur@mdanderson.org.
    • J. Am. Coll. Surg. 2019 Sep 1; 229 (3): 267276267-276.

    BackgroundLateral abdominal wall (LAW) myofascial defects are a challenging reconstructive problem, and no consensus exists on their surgical management. We hypothesized that mesh repairs anchored to the nonyielding LAW boundaries (pillar-anchored repairs [PARs]) would provide more durable reconstructions, with lower hernia recurrence and bulge occurrence rates, compared with mesh repairs anchored to the surrounding oblique muscle complexes (direct repairs [DRs]).Study DesignWe retrospectively reviewed LAW reconstructions at a single center from 2004 to 2010. Patients were divided into 2 groups based on whether they had received a PAR or a DR. The primary outcome measure was hernia recurrence. The secondary outcome measures were surgical site occurrences (SSOs), surgical site infections (SSIs), and reoperations for complications.ResultsWe analyzed 106 consecutive patients with LAW reconstructions (PAR, 59 DR, 47). The median follow-up time was 28.1 months (PAR, 24.5 months; DR, 34.5 months). The baseline demographics were similar in the groups. Nineteen hernia recurrences were observed (PAR, 5 [8.5%]; DR, 14 [29.8%]; p = 0.033, log-rank test). The "closure type" (bridged vs reinforced repair), "mesh type" or "defect area" were not associated with hernia recurrence or bulge occurrence. The groups did not differ significantly regarding SSOs, SSIs, or reoperations for complications. In the multivariable Cox proportional regression model, PAR provided a 3.5 times lower risk of hernia recurrence than DR (adjusted hazard ratio, 0.28; 95% CI 0.09 to 0.88; p = 0.03).ConclusionsThe PAR technique is superior to DR for reconstructing LAW defects in order to achieve the lowest hernia recurrence rates in this complex patient population.Copyright © 2019 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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