title: Management of recurrent hernia after components separation: 10-year experience with abdominal wall reconstruction at an academic medical center.
abstract: OBJECTIVE
  Separation of the components has become the standard of care for abdominal wall reconstruction, especially in the setting of infected, previously infected, or contaminated wounds. Although the safety and efficacy of this technique have been established, less is known about long-term outcomes. This article focuses on the management of recurrent hernia after components separation for abdominal wall reconstruction.
  
  
  METHODS
  We performed a retrospective, institutional review board-approved study of components separation for abdominal wall reconstruction at an academic medical center, over a 10-year period.
  
  
  RESULTS
  Between 2000 and 2009, we performed components separation in 136 patients (mean follow-up, 4.4 years). Twenty-six patients (19.1%) developed recurrent hernia (mean age, 49.8 years; body mass index, 30.7; previous abdominal operations, 3.5; hernia size, 342 cm; length of stay, 9.1 days). Mean time to recurrence was 319 days. Of the 16/26 patients who underwent repair of recurrence, 15 had successful repair, leaving 11/136 patients (8.1%) with persistent hernia. Of the 26 recurrences, 22 (85%) occurred within the first half of the study. Repair of recurrent hernias was accomplished by placement of additional mesh in 14/15 patients.
  
  
  CONCLUSIONS
  Recurrent hernia after components separation may be related to procedural learning curves and can be successfully treated through repeat repair, yielding high rates of successful abdominal wall reconstruction.
authors: Division of Plastic Surgery, University of North Carolina, Chapel Hill, NC, USA. cshult@med.unc.edu
authors: Charles S
authors: CS
authors: Hultman
authors: Winnie M Y
authors: WM
authors: Tong
authors: Benjamin J
authors: BJ
authors: Kittinger
authors: Bruce
authors: B
authors: Cairns
authors: D Wayne
authors: DW
authors: Overby
authors: Preston B
authors: PB
authors: Rich
mesh_terms: D034861:Abdominal Wall / Q000503:physiopathology / Q000601:surgery*; D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013524:Surgical Flaps / Q000098:blood supply; D013526:Surgical Mesh; D013529:Surgical Wound Dehiscence / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology