Abdominal Wall Reconstruction for Complex Ventral Hernias: An Early Single-Center Experience

Abstract

Background: Abdominal wall reconstruction (AWR) has emerged as an essential surgical discipline for managing complex ventral and incisional hernias. The transverse diameter of the fascial defect is an important determinant of whether retro-muscular Rives–Stoppa repair alone suffices or advanced posterior component separation via transversus abdominis release (TAR) is required to achieve tension-free midline closure. This study presents our early single-center clinical experience evaluating outcomes, technical feasibility, and complication profiles in complex ventral hernia repairs.

Methods: A prospective  observational study was conducted in the department of general surgery between October 2018 and may 2019 at NRIGH mangalagiri, guntur . Twelve adult patients (aged 18–60 years) presenting with complex, recurrent, or large incisional hernias with fascial defect  transverse diameter 5–10 cm underwent open abdominal wall reconstruction. Patients underwent either a standard Rives–Stoppa retro-muscular repair or posterior component separation with TAR (unilateral or bilateral) based on defect size and myofascial tension. Primary outcome measures included operative duration, intraoperative peak inspiratory pressure changes, postoperative surgical site infection (SSIs), and early hernia recurrence were evaluated.

Results: Among the 12 patients operated upon, eight 66.7% underwent traditional Rives–Stoppa repair and four 33.3% underwent posterior component separation with TAR. High rates of comorbidity were observed, with obesity 83.3%and type 2 diabetes mellitus 66.7%were the most common co-morbidities. Mean operative duration was 160 minutes for Rives–Stoppa and 210 minutes for TAR. Postoperative complications included seroma in 3 patients 25%, superficial surgical site infection in 2 patients 16.7% , hematoma in 1 patients 8.3%, and postoperative ventilatory support requirement in 1 patient 8.3%. 2 patients experience non-specific abdominal wall pain Intraoperative peak inspiratory pressure increased from a baseline of 21 cm H₂O to 25 cm H₂O following fascial closure, without clinical evidence of abdominal compartment syndrome. No hernia recurrence was observed during a mean follow-up of 2.5 months. Patients resumed routine functional activities at approximately one month postoperatively. Conclusion: Rives–Stoppa retrorectus repair and posterior component separation with TAR are feasible approaches for the reconstruction of complex ventral hernias. Individualizing the surgical technique according to fascial defect dimensions and intraoperative tension facilitates midline restoration with acceptable early postoperative morbidity. However, larger studies with longer follow-up are necessary to establish long-term recurrence outcomes and durability.