Abdominal Wall Tension and Early Outcomes after Posterior Component Separation with Transversus Abdominis Release: Does a "Tension-Free" Closure Really Matter?

Autor:	Miller BT; From the Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, OH (Miller, Ellis, Maskal, Petro, Krpata, Prabhu, Beffa, Rosen)., Ellis RC; From the Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, OH (Miller, Ellis, Maskal, Petro, Krpata, Prabhu, Beffa, Rosen)., Maskal SM; From the Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, OH (Miller, Ellis, Maskal, Petro, Krpata, Prabhu, Beffa, Rosen)., Petro CC; From the Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, OH (Miller, Ellis, Maskal, Petro, Krpata, Prabhu, Beffa, Rosen)., Krpata DM; From the Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, OH (Miller, Ellis, Maskal, Petro, Krpata, Prabhu, Beffa, Rosen)., Prabhu AS; From the Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, OH (Miller, Ellis, Maskal, Petro, Krpata, Prabhu, Beffa, Rosen)., Beffa LR; From the Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, OH (Miller, Ellis, Maskal, Petro, Krpata, Prabhu, Beffa, Rosen)., Tu C; Department of Statistics, Cleveland Clinic Foundation, Cleveland, OH (Tu)., Rosen MJ; From the Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, OH (Miller, Ellis, Maskal, Petro, Krpata, Prabhu, Beffa, Rosen).
Jazyk:	angličtina
Zdroj:	Journal of the American College of Surgeons [J Am Coll Surg] 2024 Jun 01; Vol. 238 (6), pp. 1115-1120. Date of Electronic Publication: 2024 Feb 19.
DOI:	10.1097/XCS.0000000000001049
Abstrakt:	Background: Ventral hernias result in fibrosis of the lateral abdominal wall muscles, increasing tension on fascial closure. Little is known about the effect of abdominal wall tension on outcomes after abdominal wall reconstruction. We aimed to identify an association between abdominal wall tension and early postoperative outcomes in patients who underwent posterior component separation (PCS) with transversus abdominis release (TAR). Study Design: Using a proprietary, sterilizable tensiometer, the tension needed to bring the anterior fascial elements to the midline of the abdominal wall during PCS with TAR was recorded. Tensiometer measurements, in pounds (lb), were calibrated by accounting for the acceleration of Earth's gravity. Baseline fascial tension, change in fascial tension, and fascial tension at closure were evaluated with respect to 30-day outcomes, including wound morbidity, hospital readmission, reoperation, ileus, bleeding, and pulmonary complications. Results: A total of 100 patients underwent bilateral abdominal wall tensiometry, for a total of 200 measurements (left and right side for each patient). Mean baseline anterior fascial tension was 6.78 lb (SD 4.55) on each side. At abdominal closure, the mean anterior fascial tension was 3.12 (SD 3.21) lb on each side. Baseline fascial tension and fascial tension after PCS with TAR at abdominal closure were not associated with surgical site infection, surgical site occurrence, readmission, ileus, and bleeding requiring transfusion. The event rates for all other complications were too infrequent for statistical analysis. Conclusions: Baseline and residual fascial tension of the anterior abdominal wall do not correlate with early postoperative morbidity in patients undergoing PCS with TAR. Further work is needed to determine if abdominal wall tension in this context is associated with long-term outcomes, such as hernia recurrence. (Copyright © 2024 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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