Early and late outcomes of component separation with transversus abdominis release with mesh augmentation versus primary suturing for the management of abdominal dehiscence: a retrospective comparative study

Abstract

Background. Abdominal dehiscence (AD) is a serious postoperative complication associated with a high risk of morbidity. Traditional primary suture repair (PS) is a simple but biomechanically deficient procedure. This study compared the early and late outcomes of posterior component separation (CS) using the transversus abdominis release (TAR) technique with mesh augmentation (MA) and PS for AD management. Materials and methods. This retrospective study included 252 patients who underwent surgical repair for complete AD Bjork Grade 1 A between January 2014 and September 2020. The patients were divided into two groups: CS + TAR+MA (Group A, n = 107) and primary suture (PS) repair (Group B, n = 145). The primary outcome was short-term morbidity (within 90 days), including surgical site occurrence (surgical site infection [SSI], hematoma, and seroma), pneumonia, ileus, and recurrent AD (RAD). The secondary outcomes were the incidence and risk factors of IH after AD repair. The patients were followed up for 5 years. Statistical analysis was performed using Kaplan-Meier survival analysis and multivariate logistic regression. Results. The baseline characteristics of the two groups were comparable. Group A was associated with a longer median operative time (92 (88–100) vs. 89 (84–91) min, p < 0.001) and mean hospital stay (11.2 ± 1.9 vs. 5.8 ± 1.5 days, p < 0.001), and higher rates of seroma (22.4% vs. 11.0%, p = 0.01) and hematoma (3.7% vs. 0%, p = 0.01). The SSI rates were comparable between the two groups (7.5% vs. 4.1%, p = 0.2). The incidence of IH was significantly lower in Group A than in Group B (5.6% vs. 13.1%, p = 0.04). Kaplan-Meier analysis confirmed the superior long-term IH-free survival in Group A (log-rank test, p = 0.009). Group A also had a lower RAD rate (1.9% vs. 7.6%, p = 0.04). Multivariate analysis revealed that PS repair (OR 40.0, 95% CI 2.1–78.0; p = 0.01), SSI (OR 13.4, 95% CI 2.3–77.6; p = 0.004), pneumonia (OR 12.3, 95% CI 1.9–77.5; p = 0.007), high BMI (OR 2.9, 95% CI 1.06–4.1; p = 0.03), ileus (OR 16.6, 95% CI 2.2-121.9; p = 0.006), RAD (OR 10.7, 95% CI 1.5–73.3; p = 0.01), infected mesh (OR 14.6, 95% CI 1.8–117; p = 0.01), and old age (OR 1.07, 95% CI 1.006–1.15; p = 0.03) significantly increased the risk of IH after AD repair. Elevated serum albumin levels were protective (OR 0.1, 95% CI 0.0–0.7; p = 0.02). Conclusion. Group A repair for AD was associated with a significantly reduced risk of IH and RAD compared to PS. Despite a higher rate of initial complications, such as seroma and hematoma, Group A provided more durable and definitive reconstruction. PS repair confers a 40-fold increased risk of IH and should be reconsidered in favor of tension-free Group A management of AD.