title: Long-term follow-up of abdominal wall reconstruction after planned ventral hernia: a 15-year experience.
abstract: BACKGROUND
  Although damage control strategies and the open abdomen have improved survival, they present their own unique set of challenges in caring for the multiply injured trauma patient. We previously reported the technique of staged abdominal wall closure for the management of the open abdomen. The purpose of this study was to evaluate the efficacy of various techniques of abdominal wall reconstruction (final stage of management) on long-term outcomes after planned ventral hernia, and to better define risk factors for recurrence.
  
  
  METHODS
  Patients undergoing abdominal wall reconstruction over a 15-year period were identified and stratified by gender, age, severity of shock, injury severity, and method of repair: secondary fascial closure +/- prosthetic, standard components separation (SCS) +/- prosthetic and modified components separation (MCS) +/- prosthetic. Long-term outcomes (recurrence) were determined using hospital records, telephone interview, and physical examination. Multivariable logistic regression analysis was performed to determine independent predictors of recurrence.
  
  
  RESULTS
  One hundred fifty-two patients were identified. Fourteen (9%) patients underwent secondary fascial closure +/- prosthetic, 47 (31%) underwent SCS +/- prosthetic, and 91 (60%) underwent MCS +/- prosthetic. Long-term follow-up (up to 14.6 years, mean 5.3 years) was obtained in 114 (75%) patients. Sixteen patients (14%) had a recurrence. Prosthetic use increased recurrence 4-fold. There were 2 known recurrences (5%) in patients with MCS without prosthetic. Logistic regression identified both female gender and body mass index as independent predictors of recurrence.
  
  
  CONCLUSIONS
  The MCS technique is the procedure of choice for repair of giant abdominal wall defects. This approach can avoid the need for prosthetics. In fact, MCS without prosthetic resulted in an acceptably low hernia recurrence rate (5%).
authors.affiliation: Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38162, USA.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: DiCocco
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Magnotti
authors.forename: Katrina P
authors.initials: KP
authors.lastname: Emmett
authors.forename: Ben L
authors.initials: BL
authors.lastname: Zarzaur
authors.forename: Martin A
authors.initials: MA
authors.lastname: Croce
authors.forename: John P
authors.initials: JP
authors.lastname: Sharpe
authors.forename: C Patrick
authors.initials: CP
authors.lastname: Shahan
authors.forename: Haiqiao
authors.initials: H
authors.lastname: Jiao
authors.forename: Steven P
authors.initials: SP
authors.lastname: Goldberg
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Fabian
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000328:Adult; D015992:Body Mass Index; D004210:Dissection; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D012008:Recurrence; D012307:Risk Factors; D012737:Sex Factors; D013526:Surgical Mesh; D013529:Surgical Wound Dehiscence / Q000453:epidemiology*; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome