Component Separation with or without Mesh Application for the Repair of Large Ventral Abdominal Wall Incisional Hernia

Background: Incisional hernia is a common long-term complication after abdominal surgery. Sound repair of large abdominal wall incisional hernia is required to be a tension free repair with low recurrence. Methods: The current study comprised 82 consecutive patients with large ventral abdominal wall incisional hernia. The study was conducted in Ain Shams University Hospitals during the period from May 2011 till August 2014. The patients were randomly classified into 2 groups: Group I (42 patients) who underwent repair of their hernias by component separation technique without application of a mesh; group II (42 patients) who underwent repair of their hernias by the component separation technique with application of polypropylene mesh. Results: Group I had the advantages of statistically significant less mean operative time (165 ±24.09 min. Compared to 195.60 ±19.42 in group II) (P<0.0001). There is less wound infection in group I (2 patients: 4.76% vs 5 patients in group II: 11.90%) (P=0.4326). There is less seroma without significant difference (P=0.5700). Group II had the advantages of a statistically significant lower recurrence rate (1 recurrence in group I ≃ 2.38%, compared to 8 recurrences in group II ≃ 19.05%) (P=0.02294). There is less post-operative anemia in group II (2 patients ≃ 4.76%, compared to 4 patients in group I ≃ 9.52%) and less skin necrosis (2 patients in group II ≃ 4.76% vs 3 patients in group I ≃ 7.14%) but the difference is insignificant (P=1). There was insignificant difference in the amount of intra-operative blood less (P=0.1255), post-operative intra-abdominal pressure (P=0.4733) and post-operative pain in 1st 48 hours (P=0.6675) between both groups. Group II had less pain in the 3rd to 7th post-operative day without statistical significance (P=0.0758). There was no significant difference between both groups in the mean hospital stay and the mean time to return to work (P=1.000 and 0.9596 respectively). Conclusion: Mesh application after component separation is ideal for the repair of large ventral abdominal wall incisional hernias offering a tension free repair with lower recurrence rate.