Outcomes of Complex Abdominal Wall Reconstruction in Patients With Connective Tissue Disorders: A Single Center Experience

Abstract Introduction Individuals diagnosed with connective tissue disorders (CTD) are known to be predisposed to incisional hernia formation. There is a scarcity of data on outcomes for these patients undergoing hernia repair. We sought to describe our outcomes in performing abdominal wall reconstructions in these complex patients. Methods We have detected adult patients with CTD undergoing open, elective, posterior component separation with permanent synthetic mesh from January 2018 to October 2022 at the Cleveland Clinic Center for Abdominal Core Health instituted. We evaluated 30-day wound morbidity, perioperative complications, long-term hernia recurrence, and patient-reported quality of life. Results Twelve patients were identified. Connective tissue disorders included Marfan’s n = 7 (58.3%), Loeys-Dietz syndrome n = 2 (16.7%), Systemic Lupus Erythematosus n = 2 (16.7%), and Scleroderma n = 1 (8.3%). Prior incisions included three midline laparotomies and nine thoracoabdominal, mean hernia width measured 14 cm, and 9 were recurrent hernias. Surgical site occurrences were observed in 25% of cases, and 16.7% necessitated procedural intervention. All twelve patients were available for long-term follow-up, with a mean of 34 (12–62) months. There were no instances of reoperation or mesh excision. One patient developed a recurrence after having his mesh violated for repair of a new visceral aneurysm. Mean HerQLes scores at 1 year were 70 and 89 at ≥2 years; Mean PROMIS scores were 30.7 at 1 year and 36.3 at ≥2 years. Conclusion Ventral hernia repair with TAR is feasible in patients with connective tissue disorder and can be a suitable alternative in patients with large complex hernias.