Perforator-sparing component separation reduces lateral pseudo-bulging in large incisional hernia repair.

Abstract

<h4>Objective</h4>To compare three-piece self-gripping mesh (SGM) onlay following perforator-sparing minimally invasive anterior component separation (MIACS) with conventional ACS plus midline-only SGM onlay in large incisional hernia repair, with wound complication rate as the primary outcome and CT-confirmed lateral pseudo-bulging as a predefined secondary outcome.<h4>Materials and methods</h4>Single-centre retrospective analysis of prospectively collected data (Jan 2020-Jan 2024). Of 97 assessed patients, 79 were analysed (MIACS n = 41; conventional ACS n = 38) after exclusions and follow-up losses. The average follow-up was 28 months.<h4>Primary endpoint</h4>24-month wound complication rate; secondary exploratory outcomes included pseudo-bulging, seroma, haematoma, and recurrence.<h4>Results</h4>The overall wound complication rate was 19.5% in Group I versus 44.7% in Group II (p = 0.012). Deep necrotic SSI was absent in Group I and occurred in 21.1% of the patients in Group II (p < 0.001). Lateral pseudo-bulging was 4.9% versus 21.1% (p = 0.001). Intraoperative blood loss (120 vs. 185 mL; p < 0.001) and therapeutic antibiotic requirement (4.9% vs. 26.3%; p = 0.008) were significantly lower in Group I. Twenty-four-month hernia recurrence rate was equivalent in both groups (4.9% vs. 5.3%; p = 1.000).<h4>Conclusion</h4>Three-piece SGM onlay following MIACS substantially prevents lateral pseudo-bulging, dramatically reduces wound morbidity, particularly deep necrotic infection, and does not affect recurrence rates. These findings provide the first comparative evidence for linea semilunaris mesh reinforcement as an adjunct to MIACS.