title: Quality of life following component separation versus standard open ventral hernia repair for large hernias.
abstract: BACKGROUND
  Component separation (CS) has become a viable alternative to repair large ventral defects when the fascia cannot be reapproximated. However, the impact of transecting the external oblique to facilitate closure of the abdomen on quality of life (QOL) has yet to be investigated. The study goal was to investigate QOL and outcomes after standard open ventral hernia repair (OVHR) versus CS for large ventral hernias.
  
  
  METHODS
  Prospective data for all CSs were reviewed and compared with matched OVHR controls. All defects were 100 to 1000 cm2 in size and repaired with mesh. Comorbidities, complications, outcomes, and Carolinas Comfort Scale (CCS) scores, were reviewed.
  
  
  RESULTS
  Seventy-four CS patients were compared with 154 patients undergoing standard OVHR with similar defect sizes. Age (56.7±13.0 vs. 54.7 ± 12.3 years, P = .26), defect sizes (299 ± 160 vs. 304 ± 210 cm2, P = .87), and BMI (32.7 ± 6.9 vs. 34.2 ± 9.0 kg/m2, P = .26) were similar in both groups, respectively. There were no differences in major postoperative complications (P = .22), mesh infections (P = 1.00), wound infections (P = .07), or hernia recurrence (P = .09), but wound breakdown increased after CS (10% vs. 1%, P < .001) as did seroma interventions (15% vs. 4%, P = .005). Postoperative CCS scores were similar at 1 month (P = .82) and 1 year (P = .14).
  
  
  CONCLUSIONS
  In the first comparative study of its kind, it is found that patient undergoing CS with mesh reinforcement had equal short- and long-term QOL outcomes compared with similar patients who underwent standard OVHR. Whereas wound breakdown and seroma formation are higher, the overall complication, mesh infection, and recurrence rates are similar.
authors.affiliation: 1Carolinas Medical Center, Charlotte, NC, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Klima
authors.forename: Victor B
authors.initials: VB
authors.lastname: Tsirline
authors.forename: Igor
authors.initials: I
authors.lastname: Belyansky
authors.forename: Kristian T
authors.initials: KT
authors.lastname: Dacey
authors.forename: Amy E
authors.initials: AE
authors.lastname: Lincourt
authors.forename: Kent W
authors.initials: KW
authors.lastname: Kercher
authors.forename: B Todd
authors.initials: BT
authors.lastname: Heniford
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011788:Quality of Life; D013526:Surgical Mesh; D016896:Treatment Outcome
keywords: Carolinas Comfort Score; component separation; incisional hernia repair; mesh; outcomes; quality of life; recurrence; ventral hernia repair