Abdominal Wall Reconstruction with the Two-step Technique: Procedure Optimization and Three-year Follow-up in 26 Surgeries

Abstract

Background: Complex or recurrent abdominal wall defects may be the result of trauma, infection, tumor resection, or a previous failed attempt at closure, among other causes. This article describes a new surgical technique that better addresses these defects and provides safety and efficacy data from 26 consecutive surgeries with a 3-year follow-up. Methods: Prospective study in 18 men and 8 women with serious abdominal wall defects, who were surgically operated on using the two-step technique, which includes a first regenerative and closure step using a vacuum device (vacuum-assisted closure), and a second reconstructive step that does not require the use of any type of surgical mesh. The safety and efficacy results were evaluated through clinical examinations and questionnaires. The severity of patient-experienced pain and both patient and surgeon satisfaction were quantified on a scale from 0 to 10 points. The statistical calculations focused on the mean (m), range (r), and percentage (%). Results: The mean complete surface area of the abdominal wall defects was 250.2 cm2 (r = 78-770 cm2). The patient and surgeon satisfaction rates at the time of hospital discharge were m = 9.0 (r = 3-10) and m = 9.4 (r = 8-10), respectively. After 3 years, these rates were m = 7.2 (r = 3-10) and m = 9.8 (r = 9-10), respectively. No relevant complications were observed in any stage of the study and no recurrence was observed 3 years later. The main complaint of patients was the presence of hypertrophic scars from the surgical wound (57% of cases). Conclusion: The two-step technique is an excellent alternative for the repair of complete abdominal wall defects of up to 800 cm2 because it allows serious complications to be avoided, prevents recurrences, and shows high rates of both patient and surgeon satisfaction.