BACKGROUND Component Separation (CST) typically involves incision of one or more fascial planes to generate myofascial advancement flaps to assist with fascial closure in ventral hernia repair (VHR). The aim of this study was to compare peri-operative outcomes and quality of life (QOL) after CST versus patients without CST (No-CST) in large, preperitoneal VHR (PPVHR). METHODS A prospective, single institution hernia study examined all patients undergoing PPVHR with synthetic mesh. Emergency and contaminated operations were excluded. A case-control cohort was identified using propensity score matching for CST and No-CST. QOL was assessed using the Carolinas Comfort Scale. RESULTS The algorithm matched 113 CST cases to 113 No-CST cases. The groups (CST vs No-CST) were similar regarding age, BMI, diabetes, smoking, defect size, mesh size, and follow-up. In univariate analysis, there was no difference in recurrence between the CST and no-CST groups (0.9% vs 0.9%, p = 1.0) or mesh infection (0.9% vs 0.0%, p = 1.0). CST did have more wound complications (29.2% vs 16.1%, p = 0.019). When controlling for panniculectomy and diabetes with multivariate logistic regression, CST continued to have had an increased risk for wound complications (OR 2.27, CI 1.16-4.47). QOL was routinely assessed. The groups were similar pre-operatively with 76.3% of CST patients and 77.8% of No-CST patients having pain (p = 1.0). At 1, 6, 12, 24, and 36 months post-operatively, the groups had equal QOL. CONCLUSION The use of CST versus No-CST in the repair of large VHs results in an increased risk of wound complications but does not increase the hernia recurrence rate. In the largest QOL comparative study to date, CST's generation of myofascial advancement flaps does not negatively impact patient QOL in the repair of large ventral hernias in the short or long term.

中文翻译：

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成分分离技术与无成分分离技术对修复大腹疝的并发症和生活质量的影响。

背景技术部件分离（CST）通常涉及切开一个或多个筋膜平面以产生肌筋膜进展性皮瓣，以协助腹侧疝修补术（VHR）中的筋膜闭合。这项研究的目的是比较大型腹膜前VHR（PPVHR）与无CST的患者（No-CST）的围手术期结局和生活质量（QOL）。方法一项前瞻性，单机构疝气研究对所有接受了人工网孔的PPVHR患者进行了检查。紧急行动和受污染的行动被排除在外。使用针对CST和No-CST的倾向得分匹配来确定病例对照队列。使用卡罗莱纳州舒适量表评估生活质量。结果该算法将113个CST案例匹配到113个No-CST案例。在年龄，BMI，糖尿病，吸烟，缺陷大小，网孔大小，和跟进。在单变量分析中，CST组和无CST组之间的复发率（0.9％vs 0.9％，p = 1.0）或网状感染（0.9％vs 0.0％，p = 1.0）没有差异。CST确实有更多的伤口并发症（29.2％比16.1％，p = 0.019）。当通过多因素logistic回归控制全脂膜切除术和糖尿病时，CST继续存在伤口并发症的风险增加（OR 2.27，CI 1.16-4.47）。定期评估生活质量。术前两组相似，有76.3％的CST患者和77.8％的No-CST患者有疼痛（p = 1.0）。术后1、6、12、24和36个月，两组的QOL均等。结论在大VHs的修复中使用CST对比No-CST会增加伤口并发症的风险，但不会增加疝的复发率。