SAC (separation of anatomical component) technique by Carbonell-Bonafé in complex incisional hernias. Our experience

Abstract

Introduction: The aim of abdominal wall complex surgery is to achieve an anatomical and functional reconstruction, providing long-lasting results. The Separation of Anatomical Component (SAC) technique amended by Carbonell-Bonafé seemed like an attractive approach for the complex incisional hernia. We present our experience and outcomes with this technique. Material and methods: A total of 50 patients with complex ventral hernias have been treated over an 8-year period (between November 2009 and October 2017). 34 patients had primary incisional hernia and 16 patients had recurrent incisional hernia. We performed a level I Carbonell-Bonafé SAC repair in 11 cases and a level II SAC in 39 cases. We follow patients for the first five years. In these patients the follow-up ranged from 2 to 60 months, with a mean follow-up of 48.56 months. Results: Mortality in one case (2%). Surgical complications: 4 patients (8%) developed cutaneous necrosis, 3 requiring surgical debridement; 6 patients (12%) had local infections but there was no need to remove the mesh. Recurrences: Excluding parastomal hernias, there were 2 recurrences in 44 patients (4,5%). One patient with a level I SAC and the other after a level II repair, 1 and 6 years after the surgery. Conclusions: The Separation of Anatomical Component (SAC) technique amended by Carbonell-Bonafé results in long-lasting repairs of highly-complex incisional hernias with a low morbidity.