A PROSPECTIVE STUDY OF ANTERIOR COMPONENT SEPARATION TECHNIQUE IN REPAIR OF LARGE VENTRAL HERNIA IN A TERTIARY CARE HOSPITAL OF WESTERN RAJASTHAN.
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Keywords
ACST, Onlay mesh
Abstract
Background: In our tertiary care hospital of western rajasthan, we attend a number of ventral hernia patients. The incidence of incisional hernia after abdominal surgery likely exceeds 20% and can result in large, complex ventral hernias with loss of abdominal domain. This study was done to see the feasibility of Anterior component separation technique (ACST) with Onlay mesh repair of large ventral hernia not amenable to primary closure. This technique can restore abdominal wall functionality for defects up to 20 cm in transverse dimension at the level of the umbilicus.
Methods: 25 patients with large ventral hernia not amenable to primary closure were repaired by ACST with Onlay mesh augmentation. Preoperative defect size mapping, Pre- and post-operative monitoring and management of comorbidities were done. Early and late complications was noted. Patients were followed up for 9 months.
Results: In our study maximum patients in both male and female sex were of age group 61–75 year (36 %) with male to female sex ratio 3:2. Most common clinical finding were swelling (100%) and pain abdomen (72%). Co-morbidity present in our patients was COPD (20%), hypertension (20%) and diabetes mellitus (16%). Risk factor linked to post-operative complications seen were obesity (32% of cases), smoking (24%), diabetes (16%) and anemia (16%). In our study 20 % of cases were of spontaneous ventral hernia and 80 % of cases were of incisional hernia. The Size of defect varied from 9–16 × 6–10 cm² (length × width). In this study post-operative complications occurred in about 32% of cases. Seroma and SSI were in 12 % of cases and 4% of cases had paralytic ileus and pneumonia. The average duration of hospital stay in our study is about 5–15 days. ACST with mesh augmentation was found to be feasible with all 25 operated patient with 0% mortality and 0% hernial recurrence rate with 9 months follow up.
Conclusion: In conclusion, CST with onlay mesh repair is an effective method in managing large ventral hernias, especially in midline defects, with low morbidity and recurrence rate and manageable complication rates despite the co morbidities, as seen in our patient population. This technique can restore abdominal wall functionality for defects up to 20 cm in transverse dimension at the level of the umbilicus.
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Dr. Lokesh Mehta
Senior Specialist, Department of General Surgery, Dr Sampurnanand Medical College, Jodhpur, Rajasthan, India.
Dr. Ganpat Singh Choudhary
Senior Professor & Head, Department of General Surgery, Dr Sampurnanand Medical College, Jodhpur, Rajasthan, India.
Dr. Vimal Soni
Assistant Professor, Department of General Surgery, JIET Medical College, Jodhpur, Rajasthan, India.
Dr. Swati Mehta
Assistant Professor, Department of Obstetrics and Gynaecology, Umaid Hospital, Jodhpur, Rajasthan, India.
Dr. Rishi Singodia
Assistant Professor, Department of General Surgery, NIMS Jaipur, Rajasthan, India.
Dr. Jatin Prajapati
Senior Resident, Department of Community Medicine, World College of Medical Sciences and Research, Jhajjar, Haryana, India (ORCID: https://orcid.org/0009-0004-7298-4499)
