Components separation technique utilizing an intraperitoneal biologic and an onlay lightweight polypropylene mesh: a sandwich technique

Reconstruction of large, complex abdominal wall hernias is an ongoing challenge. Primary closure of such hernias is often not possible. The components separation technique (CST) is a practical option, however, recurrence rates remain unacceptably high. In an attempt to reduce recurrences, we added a biologic underlay mesh and a lightweight polypropylene onlay mesh to the traditional CST. Patients with a large hernia defect with or without multiple recurrences were selected to undergo a CST augmented with an acellular porcine dermal collagen mesh underlay. Following midline abdominal closure, a lightweight, large-pore polypropylene onlay mesh was fixed to the abdominal fascia. The skin and subcutaneous layers were closed over two sump drains and two closed suction drains. Fifty-one patients underwent a mesh-reinforced CST from May 2006 to June 2010. The study population averaged 57.9 +/- A 1.5 years of age with 24 males and 27 females, BMI of 34.3 +/- A 0.9 kg/m(2), ASA score of 2.62 +/- A 0.08, 29 % were smokers, 29 % were diabetic, and 69 % had at least one previous abdominal wall hernia repair. Operative time averaged 196.5 +/- A 7.2 min with a blood loss of 318 +/- A 24 mL, and average hernia defect size of 301 +/- A 31 cm(2). Length of follow-up averaged 20.6 +/- A 2.1 months; surgical site occurrences were identified in 39 %, most commonly from skin necrosis. Hernia recurrence rate was 3.9 %. Repair of large, complex abdominal wall hernias by CST augmented with a biologic underlay mesh and a lightweight polypropylene onlay mesh results in lower recurrence rates compared to historical reports of CST alone.