Management of Difficult Abdominal Wall Problems
by Components Separation Methods:
A Preliminary Study in Thailand
Suvit Sriussadaporn MD*, Sukanya Sriussadaporn MD*,
Rattaplee Pak-art MD*, Kritaya Kritayakirana MD*,
Supparerk Prichayudh MD*, Pasurachate Samorn MD*
Affiliation :
* Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Background : Acute (open abdomen) and late (ventral hernia) abdominal wall defects are difficult surgical problems requiring
appropriate management for acceptable results. Several methods of abdominal wall reconstruction in these patients have
been introduced with varying outcomes. Components separation method (CSM) is an autologous tissue repair that has been
employed for such situations with satisfaction by many investigators. The authors have adopted this method of abdominal
wall repair or reconstruction and used it in our patients with difficult abdominal wall problems since May 2005. The aim
of the present study was to examine results of treatment of patients with large abdominal wall defects by CSM at our
institution. A brief demonstration of surgical techniques and discussion of the related issues were also made.
Material and Method: All patients with difficult abdominal wall problems treated by CSM at King Chulalongkorn Memorial
Hospital, Bangkok, Thailand between May 2005 and June 2012 were examined and analyzed. The patients were divided
into two groups, i.e. acute (open abdomen) and late (ventral hernia). Different methods of repair or reconstruction by CSM
were described. No prosthetic mesh was used in the present study. Postoperative follow-up was done until August 2012.
Operative morbidity and late sequelae were studied.
Results : Twenty-six patients entered into the study. Eight (30.8%) underwent closure of acute abdominal wall defects and
18 (69.2%) underwent late ventral hernia repair. Four patients (50%) who underwent closure of acute abdominal wall
defects also had closure of associated entero-atmospheric or small bowel fistulae. Four patients (22.2%) who underwent
late ventral hernia repair also had closure of associated ileostomy or colostomy. Three types of CSM were used in the present
study; i.e. original or standard components separation (SCS), modified components separation (MCS), and SCS plus bilateral
anterior rectus abdominis sheath turnover flap (RSTF). Complications included seroma under the skin flap in one patient
in the early closure group, two wound infections, two seroma under the skin flap, and one skin flap dehiscence in the late
ventral hernia repair group. One small, asymptomatic recurrent ventral hernia was found during the follow-up period of
the late ventral hernia repair patients (5.6%).
Conclusion : CSM is a good alternative for management of difficult abdominal wall problems, especially in situations that
employment of prosthetic mesh may be inappropriate. Its advantages are avoidance of prosthetic mesh and low risk of
infection in potentially infected environment. It is versatile in various abdominal wall problems even in large abdominal
wall defects. CSM is recommended when associated enteric fistula, ileostomy, colostomy closure, or other potentially infected
procedures are simultaneously performed.
Keywords : Acute abdominal wall defect, Open abdomen, Ventral hernia, Components separation method, Modified
components separation method
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