Abstract：
Patients with complex incisional hernia (IH) is a growing and challenging category that surgeons are facing in daily practice and represent indeed a technical challenge for most of them. The posterior component separation with TAR (PCS-TAR) has become the procedure of choice to repair most complex abdominal wall defects, including those with loss of domain, subxiphoid, subcostal, parastomal or after trauma and sepsis treated initially with \"open abdomen\" and in those scenarios in which the fascia closure was not performed to avoid an abdominal compartment syndrome. Most recent studies showed that the PCS-TAR represents a valid procedure in recurrent IH. The purpose of our study is to evaluate the reproducibility of the PCS-TAR, describing our experience, our surgical technique and the rate of postoperative complications and recurrences in a cohort of consecutive patients. 52 consecutive patients with complex IH, who underwent PCS-TAR at \"Betania Hospital and Ospedale del Mare Hospital\" in Naples between May 2014 and November 2019 were identified from a prospectively maintained database and reviewed retrospectively. There were 36 males (69%) and 16 females (31%) with a mean age of 57.88 (range 39-76) and Body mass index (BMI kg/m2) of 31.2 (24-45). More than half of patients (58%) were active smokers. Mean defect width was 13.6 cm (range 6-30) and mean defect area was about 267.9 cm2. Mean operative time was 228 min. Posterior fascial closure was reached in all cases, while anterior fascial closure only in 29 cases (56%). Mean hospital stay was 5.7 days. 27% of patients developed minor complications (Clavien-Dindo grade I-II) and one case (1.9%) major complication (Clavien-Dindo III). Seroma was registered in 23% of cases. SSI was reported to be 3.8% with no deep wound infection. Recurrence rate was 1.9% in a mean follow-up of 28 months. In Univariate analysis Bio-A surface > 600 cm2 and drain removal at discharge were significantly associated with major complications, while in a multivariate analysis only Bio-A surface > 600 cm2 was related. Considering univariate analysis for recurrences, number of drains, SSO, Clavien-Dindo score > 2 and defect area were significantly associated with recurrence, while in a multivariate analysis no variables were related. PCS-TAR is an indispensable tool in managing complex ventral hernias associated with a low rate of SSO and recurrence. Tobacco use, obesity and comorbidities cannot be considered absolute contraindications to PCS-TAR. Peri and postoperative management of complications and drainages have an impact on short term outcomes. Based on these outcomes, posterior component separation with transversus abdominis release has become our method of choice for the management of patients with complex ventral hernia requiring open hernia repair in selected patients.
摘要：
复杂切口疝（IH）患者是外科医生在日常实践中面临的一个不断增长且具有挑战性的类别，对大多数人来说确实是一个技术挑战。TAR的后部组件分离（PCS-TAR）已成为修复大多数复杂腹壁缺损的首选方法，包括那些失去域名的人，剑突下,肋下,造口旁或创伤和败血症后，最初接受“开放腹部”治疗，以及在未进行筋膜闭合以避免腹腔室综合征的情况下。最近的研究表明，PCS-TAR代表了复发性IH的有效程序。我们研究的目的是评估PCS-TAR的可重复性，描述我们的经历，我们的手术技术以及一组连续患者的术后并发症和复发率。连续52例复杂IH患者，2014年5月至2019年11月在那不勒斯的“Betania医院和OspedaledelMare医院”接受PCS-TAR的患者从前瞻性维护的数据库中进行鉴定,并进行了回顾性审查.有36名男性（69％）和16名女性（31％），平均年龄为57.88（范围39-76），体重指数（BMIkg/m2）为31.2（24-45）。超过一半的患者（58％）是活跃的吸烟者。平均缺损宽度为13.6cm(范围6-30),并且平均缺损面积为约267.9cm2。平均手术时间为228分钟。所有病例均达到后筋膜闭合,而前筋膜闭合仅29例(56%)。平均住院时间为5.7天。27％的患者出现轻微并发症（Clavien-DindoI-II级）和1例（1.9％）主要并发症（Clavien-DindoIII）。在23%的病例中登记了血清腺瘤。据报道，SSI为3.8％，没有深部伤口感染。平均随访28个月，复发率为1.9%。在单变量分析中，Bio-A表面>600cm2和排出时的引流管去除与主要并发症显着相关。而在多变量分析中,仅Bio-A表面>600cm2是相关的。考虑到复发的单变量分析，排水沟数量,SSO,Clavien-Dindo评分>2和缺损面积与复发显著相关,而在多变量分析中，没有变量相关。PCS-TAR是治疗与低SSO和复发率相关的复杂腹侧疝不可或缺的工具。烟草使用,肥胖和合并症不能视为PCS-TAR的绝对禁忌症.围手术期和术后并发症和引流的管理对短期结果有影响。基于这些结果,腹横肌释放后成分分离已成为我们治疗复杂腹侧疝患者的首选方法，需要在选定的患者中进行开放式疝修补术。
