Component Separation vs. Bridged Repair for Large XXXX : A Multi-Institutional Risk-Adjusted Comparison, Systematic Review, and Meta-Analysis.

@entity1 @entity154 @entity39 @entity2080 @entity281 @entity1410 @entity2483 @entity4037
BACKGROUND: Repair of large @entity4037 is associated with high rates of surgical site occurrences (SSO), including @entity281 ( @entity281 ), site dehiscence, @entity2080 , @entity1410 , and site @entity39 . Two common operative strategies exist: @entity2483 ( @entity2483 ) with primary fascial closure and mesh reinforcement (PFC- @entity2483 ) and bridged repair (mesh spanning the @entity154 ). We hypothesized that: (1) @entity4037 repair (VHR) of large defects with bridged repair is associated with more SSOs than is PFC, and (2) anterior @entity2483 is associated with more SSOs than is endoscopic, perforator-sparing, or posterior @entity2483 . METHODS: Part I of this study was a review of a multi-center database of @entity1 who underwent VHR of a defect >= 8   cm from 2010-2011 with at least one month of follow-up. The primary outcome was SSO. The secondary outcome was recurrence. Part II of this study was a systematic review and meta-analysis of studies comparing bridged repair with PFC and studies comparing different kinds of @entity2483 . RESULTS: A total of 108 @entity1 were followed for a median of 16   months (range 1-50   months), of whom 84 underwent PFC- @entity2483 and 24 had bridged repairs. Unadjusted results demonstrated no differences between the groups in SSO or recurrence; however, the study was underpowered for this purpose. On meta-analysis, PFC was associated with a lower risk of SSO (odds ratio [OR]   =   0.569; 95% confidence interval [CI]   =   0.34-0.94) and recurrence (OR   =   0.138; 95% CI   =   0.08-0.23) compared with bridged repair. On multiple-treatments meta-analysis, both endoscopic and perforator-sparing @entity2483 were most likely to be the treatments with the lowest risk of SSO and recurrence. CONCLUSIONS: Bridged repair was associated with more SSOs than was PFC, and PFC should be used whenever feasible. Endoscopic and perforator-sparing @entity2483 were associated with the fewest complications; however, these conclusions are limited by heterogeneity between studies and poor methodological quality. These results should be used to guide future trials, which should compare the risks and benefits of each @entity2483 method to determine in which setting each technique will give the best results.
