2008 Annual Meeting Abstracts
Minimally Invasive Component Separation for Abdominal Wall Reconstruction
charles M. ferguson, md.
Massachusetts General Hospital, Boston, MA, USA.
Objective: To describe a minimally invasive method for component separation to reconstruct the abdominal wall in difficult circumstances and the short term results obtained with it.
Design: Retrospective review of cases in which minimally invasive component separation was used.
Setting: Tertiary care, university hospital
Patients: Patients with large abdominal wall defects requiring reconstruction
Interventions: Minimally invasive component separation (technique to be demonstrated in a short video). This technique involves component separation through small flank incisions, thus perserving the abdominal wall perforating vessels and blood supply to the abdominal wall.
Main Outcome Measures: Ability to close the abdominal wall, primary wound closure without infection, and absence of hernia in short followup.
Results: Four patients (aged 41-63) with complex past surgical history (mean of 10 previous laparotomies) had minimally invasive component separation for abdominal wall reconstruction with repair of intestinal fistula (3) or closure of colostomy (1). Mean abdominal wall defect pre-operatively was 737.5cm2 (range 150-2000cm2). Patients had minimally invasive component separation with primary closure and onlay graft (1), inlay graft (2), and underlay graft (1). All wounds healed primarily without significant wound complications, and remain hernia free with very short followup (mean 1.5 months).
Conclusions: Minimally invasive component separation is a useful adjunct in reconstruction of the abdominal wall. Though the incidence of re-herniation is unkown, it allows for primary closure and healing by primary intention in wounds that could not otherwise be so closed.