Component separation in ventral hernia repair shows long-term protective impact on recurrence: JAMA

A new study published in the Journal of American Medical Association found that component separation appears to have a protective effect on long-term operative recurrence following ventral hernia repair among Medicare seniors. Component separation is a reconstructive procedure used to allow midline closure of big or complicated ventral hernias. The prevalence and long-term effects following component separation are unclear, despite a recent spike in popularity. To assess the frequency and long-term results of component separation for abdominal wall hernia repair, Brian Fry and his team carried out this investigation.

From January 1, 2007, to December 31, 2021, 100% of Medicare administrative claims data were analyzed in this cohort research. Adults (≥18 years old) who had elective inpatient ventral hernia repair were the participants. The primary exposure occurred during the closure of a ventral hernia when the component separation approach was used. The main results were the rates of operational recurrence up to 10 years following surgery for hernia repairs with and without component separation, as well as the incidence of component separation with time. The rate of surgical recurrence following component separation, stratified by surgeon volume, was the secondary outcome.

The average age of the 2,18,518 patients who had their ventral hernia repaired was 69.1 years and 90,661 (41.5%) of the patients were men and 127 857 (58.5%) were women. Component separation was performed on 23,768 patients in order to correct abdominal wall hernias. Following index hernia surgery, the median (IQR) follow-up period was 7.2 (2.7 to 10) years. The patients having repair with component separation were somewhat younger, more likely to be male, more likely to have comorbidities, such as obesity, and had operations that were more likely to be open and employ mesh than those without component separation.

From 1.6% of all inpatient hernia procedures in 2007 (279 patients) to 21.4% in 2021, proportional utilization of component separation grew. When compared to hernia surgeries done without component separation, the 10-year adjusted surgical recurrence rate following component separation was reduced. The top 5% of surgeons by component separation volume had a decreased rate of operational recurrence when compared to the lowest 95% of surgeons by volume. Overall, although surgeon volume was linked to just a little decrease in recurrence rates, component separation seems to have a protective impact on long-term surgical recurrence.

Source:

Fry, B. T., Schoel, L. J., Howard, R. A., Thumma, J. R., Kappelman, A. L., Hallway, A. K., Ehlers, A. P., O’Neill, S. M., Rubyan, M. A., Shao, J. M., & Telem, D. A. (2024). Long-Term Outcomes of Component Separation for Abdominal Wall Hernia Repair. In JAMA Surgery. American Medical Association (AMA). https://doi.org/10.1001/jamasurg.2024.5091