We conducted a comprehensive retrospective review of consecutive patients who underwent AWR performed independently by microsurgical fellows to repair abdominal wall hernias or oncologic resection defects. The surgical technique employed in this study was consistent across all patients, as previously described.10 (link)–16 (link) We performed anterior component separation with release of the external oblique aponeurosis in almost all cases. Regardless of the level of contamination, the intention in all cases was to perform a single staged reconstruction. Regardless of prior experience with AWR, fellows were generally trained on the AWR techniques that were consistently performed at the authors’ institution.10 (link)–12 (link) Patient selection was based on patient availability and did not follow any selection criteria. A trainee had to have complete autonomy in preoperative, intraoperative, and postoperative care and decision-making to be considered the operative surgeon for a case. Direct and indirect supervision was available if requested by the trainee.
Surgical outcomes included hernia recurrence rate, surgical site occurrence (SSO), surgical site infection (SSI), 30-day readmission, return to operating room rates, and length of hospital stay. Hernia recurrence was defined as a contour abnormality with associated fascial defect diagnosed via physical examination and/or abdominal imaging with either computed tomography or magnetic resonance imaging. An SSO was defined as skin necrosis, fat necrosis, wound dehiscence, infection, hematoma, seroma, or enterocutaneous fistula. SSIs consisted of infectious processes, either abscesses or cellulitis, requiring treatment with antibiotics with or without drainage. Rectus muscle violation was defined as an existing or new ostomy, gastrostomy/jejunostomy tube placement, transversely divided rectus abdominis muscle, and/or resected rectus abdominis muscle.
Surgical outcomes included hernia recurrence rate, surgical site occurrence (SSO), surgical site infection (SSI), 30-day readmission, return to operating room rates, and length of hospital stay. Hernia recurrence was defined as a contour abnormality with associated fascial defect diagnosed via physical examination and/or abdominal imaging with either computed tomography or magnetic resonance imaging. An SSO was defined as skin necrosis, fat necrosis, wound dehiscence, infection, hematoma, seroma, or enterocutaneous fistula. SSIs consisted of infectious processes, either abscesses or cellulitis, requiring treatment with antibiotics with or without drainage. Rectus muscle violation was defined as an existing or new ostomy, gastrostomy/jejunostomy tube placement, transversely divided rectus abdominis muscle, and/or resected rectus abdominis muscle.
