Complex abdominal wall hernias: A new classification system and approach to management based on review of 133 consecutive patients

Josef G. Hadeed, Mark D. Walsh, Theodore N. Pappas, Ivo A. Pestana, Douglas S. Tyler, Howard Levinson, Christopher Mantyh, Danny O. Jacobs, Sandhya A. Lagoo-Deenadalayan, Detlev Erdmann

Research output: Contribution to journalArticle

31 Scopus citations

Abstract

Background: Plastic surgeons are increasingly involved in the repair of complex ventral hernias. Although this typically involves recurrent incisional hernias, operative strategies can be applied to most abdominal wall defects, including chronic wounds with or without exposed mesh, enterocutaneous fistulas, or hernias associated with significant pannus formation. Methods: This is a retrospective review of a single institution/single surgeon experience of complex ventral hernia repair performed over a 5-year period. Patients were classified into different hernia types based on their characteristics and underwent hernia repair according to the presented algorithm. Results: A total of 133 patients underwent a complex ventral hernia repair between January 2005 and September 2009. The separation of components technique was used in the majority of cases. Permanent or biologic mesh was added in select patients. Adjunctive procedures were performed as indicated. The majority of short-term (less than 1 year) recurrences occurred in patients expected to have impaired wound healing due to comorbid conditions. In these patients, the recurrence rate was reduced when autologous repair was reinforced with mesh. Conclusion: Autologous tissue is the preferred method for reconstruction of complex ventral hernias. In certain instances, such as contamination, use of an acellular dermal matrix mesh is added as a temporizing measure. A subset of patients who will be prone to recurrence remains. Long-term follow-up is needed to confirm reliable and reproducible results.

Original languageEnglish (US)
Pages (from-to)497-503
Number of pages7
JournalAnnals of plastic surgery
Volume66
Issue number5
DOIs
StatePublished - May 1 2011

Keywords

  • Hernia
  • abdominal wall reconstruction
  • complex abdominal wall reconstruction
  • complex hernias

ASJC Scopus subject areas

  • Surgery

Fingerprint Dive into the research topics of 'Complex abdominal wall hernias: A new classification system and approach to management based on review of 133 consecutive patients'. Together they form a unique fingerprint.

  • Cite this

    Hadeed, J. G., Walsh, M. D., Pappas, T. N., Pestana, I. A., Tyler, D. S., Levinson, H., Mantyh, C., Jacobs, D. O., Lagoo-Deenadalayan, S. A., & Erdmann, D. (2011). Complex abdominal wall hernias: A new classification system and approach to management based on review of 133 consecutive patients. Annals of plastic surgery, 66(5), 497-503. https://doi.org/10.1097/SAP.0b013e3182145387