Combining anterior and posterior component separation for extreme cases of abdominal wall reconstruction.

PURPOSE: The closure of midline in abdominal wall incisional hernias is an essential principle. In some exceptional circumstances, despite adequate component separation techniques, this midline closure cannot be achieved. This study aims to review the results of using both anterior and component separation in these exceptional cases. METHODS: We reviewed our experience using the combination of both anterior and posterior component separation in the attempt to close the midline. Our first step was to perform a TAR and a complete extensive dissection of the retromuscular preperitoneal plane developed laterally as far as the posterior axillary line. When the closure of midline was not possible, an external oblique release was made. A retromuscular preperitoneal reinforcement was made with the combination of an absorbable mesh and a 50 × 50 polypropylene mesh. RESULTS: Twelve patients underwent anterior and posterior component separation. The mean hernia width was 23.5 ± 5. The majority were classified as severe complex incisional hernia and had previous attempts of repair. After a mean follow-up of 27 months (range 8-45), no case of recurrence was registered. Only one patient (8.33%) presented with an asymptomatic bulging in the follow-up. European Hernia Society's quality of life scores showed a significant improvement at 2 years postoperatively in the three domains: pain (p = 0.01), restrictions (p = 0.04) and cosmetic (p = 0.01). CONCLUSIONS: The combination of posterior and anterior component separation can effectively treat massive and challenging cases of abdominal wall reconstruction in which the primary midline closure is impossible to achieve despite appropriate optimization of surgery.

La unidad de cuidados intensivos en el postoperatorio de cirugía mayor abdominal / The intensive care unit in the postoperative period of major abdominal surgery

A pesar de una baja mortalidad en los pacientes sometidos a procedimientos de cirugía mayor abdominal, el número de pacientes con alto riesgo aumenta cada día, convirtiendo a esta en un problema de salud. En la actualidad la cirugía se entiende como un proceso continuo en el que el resultado final depende de numerosas pautas sumadas a técnicas menos invasivas que ofrezcan menor impacto fisiológico sobre pacientes con graves comorbilidades. La prevención, el reconocimiento y el tratamiento precoz de las complicaciones se hacen tan importantes como el preoperatorio o la técnica quirúrgica.?La instauración de los protocolos Enhaced Recovery After Surgery es la piedra angular para el tratamiento de estos pacientes, dado que la mayoría de las sociedades quirúrgicas reconocen que reduce la mortalidad, la duración del ingreso y los costes hospitalarios. El manejo postoperatorio de estos pacientes en las unidades de cuidados intensivos garantiza la efectividad y la eficiencia para contribuir al mantenimiento de la prestación de servicios de salud

Despite low mortality in patients undergoing major abdominal surgery, the number of high-risk patients is increasing and has become a health problem. At present, surgery is understood as a continuous process, in which numerous guidelines added to less invasive techniques offering a lesser physiological impact upon patients with serious comorbidities are responsible for the final outcome. The prevention, identification and early treatment of complications prove as important as the preoperative or surgical technique.?The introduction of ERAS (enhanced recovery after surgery) protocols is the cornerstone for the management of these patients, and is advocated by most surgical societies for reducing mortality, length of hospital stay and hospital costs. The postoperative management of these patients in postsurgery Intensive Care Units guarantees effectiveness and efficiency in maintaining optimum patient care

The intensive care unit in the postoperative period of major abdominal surgery. / La unidad de cuidados intensivos en el postoperatorio de cirugía mayor abdominal.

Despite low mortality in patients undergoing major abdominal surgery, the number of high-risk patients is increasing and has become a health problem. At present, surgery is understood as a continuous process, in which numerous guidelines added to less invasive techniques offering a lesser physiological impact upon patients with serious comorbidities are responsible for the final outcome. The prevention, identification and early treatment of complications prove as important as the preoperative or surgical technique.?The introduction of ERAS (enhanced recovery after surgery) protocols is the cornerstone for the management of these patients, and is advocated by most surgical societies for reducing mortality, length of hospital stay and hospital costs. The postoperative management of these patients in postsurgery Intensive Care Units guarantees effectiveness and efficiency in maintaining optimum patient care.