Objectives: To determine the efficacy and describe the evolution of the "components separation" technique for abdominal wall repair in 200 consecutive patients. Design: Retrospective medical record review. Setting: Northwestern Memorial Hospital, Chicago, Illinois. Patients: Two hundred consecutive patients who underwent ventral hernia repair using the components separation technique. Interventions: Biological and permanent meshes were used in select patients to augment the repair of the midline fascial closure but were not used as "bridging" materials. Main Outcome Measures: Hernia recurrence rates and major and minor complication rates for the overall series and for the different techniques. Results: Primary components separation (n=158) yielded a 22.8% recurrence rate. Closure of the midline tissues with augmentation of the repair using an acellular cadaveric dermis underlay (n=18) had a 33.3% recurrence rate requiring a second operation, whereas intra-abdominal soft polypropylene mesh (n=18) had 0% recurrence (P=.04). Elevated body mass index was a significant risk factor predicting hernia recurrence (P=.003).Contamination(P=.04) and enterocutaneous fistula (P=.02) at the time of surgery wereassociatedwithincreasedmajorcomplications,whereas body mass index (P=.01) and diabetes mellitus (P=.04) were associated with increased minor complications. Conclusions: Large complex hernias can be reliably repaired using the components separation technique despite the presence of open wounds, the need for bowel surgery, and numerous comorbidities. The long-term strength of the hernia repair is not augmented by acellular cadaveric dermis but seems to be improved with soft polypropylene mesh.
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