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Material and Method: All patients with difficult abdominal wall problems treated by CSM at King Chulalongkorn Memorial Hospital, Bangkok, Thailand between May 2005 and June 2012 were examined and analyzed. The patients were divided into two groups, i.e. acute (open abdomen) and late (ventral hernia). Different methods of repair or reconstruction by CSM were described. No prosthetic mesh was used in the present study. Postoperative follow-up was done until August 2012. Operative morbidity and late sequelae were studied.
Results: Twenty-six patients entered into the study. Eight (30.8%) underwent closure of acute abdominal wall defects and 18 (69.2%) underwent late ventral hernia repair. Four patients (50%) who underwent closure of acute abdominal wall defects also had closure of associated entero-atmospheric or small bowel fistulae. Four patients (22.2%) who underwent late ventral hernia repair also had closure of associated ileostomy or colostomy. Three types of CSM were used in the present study; i.e. original or standard components separation (SCS), modified components separation (MCS), and SCS plus bilateral anterior rectus abdominis sheath turnover flap (RSTF). Complications included seroma under the skin flap in one patient in the early closure group, two wound infections, two seroma under the skin flap, and one skin flap dehiscence in the late ventral hernia repair group. One small, asymptomatic recurrent ventral hernia was found during the follow-up period of the late ventral hernia repair patients (5.6%).
Conclusion: CSM is a good alternative for management of difficult abdominal wall problems, especially in situations that employment of prosthetic mesh may be inappropriate. Its advantages are avoidance of prosthetic mesh and low risk of infection in potentially infected environment. It is versatile in various abdominal wall problems even in large abdominal wall defects. CSM is recommended when associated enteric fistula, ileostomy, colostomy closure, or other potentially infected procedures are simultaneously performed.
Keywords: Acute abdominal wall defect, Open abdomen, Ventral hernia, Components separation method, Modified components separation method