Demetrashvili Zaza, Pipia Irakli, Patsia Lali, Kenchadze George, Tkhelidze Luka, Kamkamidze George
Department of Surgery, Tbilisi State Medical University, 33, Vazha-Pshavela Ave. 0177, Tbilisi, Georgia.
Department of Surgery, Kipshidze Central University Hospital, 29, Vazha-Pshavela Ave. 0160, Tbilisi, Georgia.
Updates Surg. 2025 May 13. doi: 10.1007/s13304-025-02229-7.
The aim of this study was to analyze outcomes of open anterior component separation technique (ACST) and posterior component separation technique with transversus abdominis release (TAR) for midline large ventral hernias. From December 2016 to July 2022, patients over 18 years of age, who underwent elective surgery for midline large ventral hernia via open component separation technique (ACST and TAR), were enrolled in this study. Preoperative and intraoperative factors, also hospital stay days, Surgical Site Occurrences (SSO), hernia recurrence and quality of life (QoL) were determined in ACST and TAR groups. To determine QoL we used the Carolinas Comfort Scale (CCS). Data of 43 patients (22 patients from ACST group and 21-from TAR group) were analyzed. Bivariate analysis showed that the proportions of SSO in TAR group (4 out of 21; 19%) was significantly lower than in ACST group (11 out of 22; 50%) (OR 1.87, 95% CI 1.07-3.24, p = 0.033). Seroma was the most frequent SSO, ranging from 9.5% to 40.9% among the groups, respectively (P = 0.018). There was no significant difference between the groups in terms of surgical site infection (SSI), hematoma, wound dehiscence, skin necrosis, hernia recurrence and QoL. Our study revealed that when comparing the ACST and TAR groups for large midline ventral hernia, there was no significant difference in terms of hernia recurrence and QoL. TAR was associated with significantly less SSO than ACST. This can be considered as an advantage of TAR, making it more preferable than ACST.
本研究旨在分析开放性前侧成分分离技术（ACST）和带腹横肌松解的后侧成分分离技术（TAR）治疗中线大型腹侧疝的效果。2016年12月至2022年7月，年龄超过18岁、通过开放性成分分离技术（ACST和TAR）接受择期手术治疗中线大型腹侧疝的患者纳入本研究。在ACST组和TAR组中确定术前和术中因素、住院天数、手术部位事件（SSO）、疝复发情况和生活质量（QoL）。为了确定生活质量，我们使用了卡罗莱纳舒适度量表（CCS）。分析了43例患者的数据（ACST组22例，TAR组21例）。双变量分析显示，TAR组的SSO比例（21例中的4例；19%）显著低于ACST组（22例中的11例；50%）（OR 1.87，95%CI 1.07 - 3.24，p = 0.033）。血清肿是最常见的SSO，两组中分别为9.5%至40.9%（P = 0.018）。两组在手术部位感染（SSI）、血肿、伤口裂开、皮肤坏死、疝复发和生活质量方面无显著差异。我们的研究表明，比较ACST组和TAR组治疗大型中线腹侧疝时，疝复发和生活质量方面无显著差异。与ACST相比，TAR的SSO明显更少。这可被视为TAR的一个优势，使其比ACST更可取。
