title: Posterior component separation and transversus abdominis muscle release for complex incisional hernia repair in patients with a history of an open abdomen.
abstract: BACKGROUND
  The best reconstructive approach for large fascial defects precipitated from a previous open abdomen has not been elucidated to date. We use a posterior component separation with transversus abdominis muscle release (TAR) in this scenario.
  
  
  METHODS
  Patients with a history of an open abdomen who ultimately underwent complex hernia repair with TAR from 2010 to 2013 at Case Medical Center were identified in our prospective database and analyzed.
  
  
  RESULTS
  Of 34 patients (mean [SD] age, 54 [11.3] years; mean [SD] body mass index, 32.5 [7.2]) with a history of an open abdomen, the fascia was closed primarily in 11 and skin alone closed primarily in 4 patients after a mean (SD) of 5.9 (6.7) days. Those unable to achieve primary closure either received a skin graft (n = 16) or healed by secondary intention (n = 3). Patients presented to our institution a mean (SD) of 25.1 (26.5) months after their initial operation, eight having already undergone at least one hernia repair, including four anterior component separations. Operations consisted of 21 (61.8%) contaminated cases, including 7 enterocutaneous fistula takedowns, 2 stoma revisions, 2 stoma reversals, and 3 excisions of infected mesh. Wound morbidity consisted of 12 (35%) surgical site occurrences: 1 wound dehiscence, 2 hematomas, 1 seroma, 8 surgical site infections (23.5%; 3 superficial, 3 deep, and 2 organ space), and no enterocutaneous fistulas or chronic mesh infections. One reoperation was necessary for debridement of a hematoma and deep surgical site infection. With a mean follow-up of 18 months (range, 3-42 months), two (5.9%) new parastomal hernias and three (8.8%) midline recurrences have been documented.
  
  
  CONCLUSIONS
  To our knowledge, this is the first report describing the use of TAR in patients with a history of an open abdomen for definitive abdominal wall reconstruction. We have demonstrated that this approach is associated with low significant perioperative morbidity and recurrence.
  
  
  METHODS
  Therapeutic study, level V.
authors.affiliation: From the Case Comprehensive Hernia Center (C.C.P., S.Y., A.S.P., Y.W.N., M.J.R.), University Hospitals Case Medical Center; and Division of Trauma Critical Care, Burns, and Acute Care Surgery (C.C.P., J.J.C., S.Y.), MetroHealth Medical Center, Cleveland, Ohio.
authors.forename: Clayton C
authors.initials: CC
authors.lastname: Petro
authors.forename: John J
authors.initials: JJ
authors.lastname: Como
authors.forename: Sydney
authors.initials: S
authors.lastname: Yee
authors.forename: Ajita S
authors.initials: AS
authors.lastname: Prabhu
authors.forename: Yuri W
authors.initials: YW
authors.lastname: Novitsky
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rosen
mesh_terms: D000007:Abdominal Injuries / Q000601:surgery*; D000009:Abdominal Muscles / Q000601:surgery*; D005260:Female; D046449:Hernia, Abdominal / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D016038:Skin Transplantation; D013526:Surgical Mesh; D054047:Surgical Stomas; D013530:Surgical Wound Infection / Q000601:surgery*; D016896:Treatment Outcome