Component separation technique for giant incisional hernia: A systematic review - 20/03/18
, Dirk De Bacquer b, Frederik Berrevoet aAbstract |
The component separation technique (CST) has gained popularity among general surgeons in the management of giant abdominal hernia.
A systematic review of the MedLine and EMBASE databases was performed. 36 observational cohort studies were included for data-analysis and divided in 4 main groups: Open Anterior Approach (OAA), Transversus Abdominis Release (TAR), Laparoscopic Anterior Approach (LAA) and Perforator Preserving Approach (PPA). Surgical Site Occurrences (SSO) occurred in 21.4%, 23.7%, 20.3% and 16.0% respectively. Incidence of recurrence was 11.9% (OAA), 5.25% (TAR), 7.02% (LAA) and 6.47% (PPA) with a significant difference in the advantage of TAR over OAA (p < 0.001).
Limitations in this systematic review were a lack of randomized trials, a heterogenous population and non-standardized methods for measuring outcomes, all making it difficult to postulate conclusions about CST and its modifications. Based on pooled results of 36 studies, the prevalence of SSO is comparable between the techniques with an average of one in five and the prevalence of recurrences is highest when using the Open Anterior Approach at 11.9%.
Il testo completo di questo articolo è disponibile in PDF.Highlights |
• | This review focuses on giant hernias with loss of domain and its management using the component separation technique. |
• | Outcomes considered in this article are surgical site occurrences (SSO) and recurrences. |
• | Variations are transversus abdominis release (TAR), open anterior (OAA), laparoscopic anterior (LAA) and perforator preserving approach (PPA) |
• | OAA showed SSO in 21.4%. This was 23.7% for TAR, 20.3% for LAA and 16.0% for the PPA with no statistical differences. |
• | Prevalence of recurrences was 11.9% in OAA, 5.3% in TAR, 7.0% in LAA and 6.5% in PPA with differences in mean follow-up time. |
• | Due to numerous confounding variables and lack of appropriate randomized studies, it is difficult to postulate exact conclusions in this study. |
Mappa
Vol 215 - N° 4
P. 719-726 - aprile 2018 Ritorno al numero
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