Onlay Classical Repair versus Component Separation Technique in Large Incisional Hernias: Early Complications and Recurrence

Background: Ventral abdominal wall hernias present a formidable and growing challenge that complicates 11% to 23% of all abdominal laparotomies. Herein, we present technical details, evaluate and compare outcomes of Onlay technique and open perforator preserving anterior component separation in a series of patients undergoing large midline incisional hernia repair.
Objective: To compare between two techniques for repair of huge incisional hernias regard complications (Seroma, infection, wound dehiscene and early recurrence).
Patients and methods: This was a prospective, comparative study that was conducted at Ain Shams University Hospital, For 12 months with minimal follow up 6 months. There were two groups of patient, each Groups 15 patients, Group A for onlay classical repair technique and group B for open perforator preserving anterior component separation technique (CST).
Results: Our study revealed that, the mean of operation time was 121.33 in Group A and 153.27 in Group B, with highly statistically significant difference. The mean of Hernia size was 91.10 in Group A and 105.87 in Group B. The mean of hospital stay (days) was 5.61 in Group A and 5.40 in Group B with no statistically significant difference.
Our study revealed that, wound complications occurrence was (73.3%) in Group A and (20.0%) in Group B, with highly statistically significant difference. Wound infection was (9.1%) in Group A and (33.3%) in Group B. One case in Group B had hematoma. Seroma was (90.9%) in Group A and (33.3%) in Group B with statistically significant difference. The present study showed that, the rate of recurrence in Group A was (13.3%) and (6.7%) in Group B, with no statistically significant difference.
Conclusion: Post-operative Wound complications and wound seroma in classical repair significantly increased than component separation, but Wound infection significantly increased in component separation than classical repair.
Only one case in component separation had Hematoma. No significant difference was found as regard the rate of recurrence between the two groups. Operation time was higher in component separation than classical repair.