A Variation of the Components’ Separation Technique that Preserves the Semilunaris for Treatment of Abdominal Wall Deformities

The variation of the components’ separation technique, which uses the anterior rectus sheath and the release of the oblique muscles, proved to be effective in tension reduction. This paper aimed to present the initial experience using a variation that preserves semilunaris through the incision of the lateral aspect of the rectus sheath. All of the 12 patients presented an abdominal wall defect that included incisional hernia, peritoneostomy, lateral implantation of the rectus muscle, and defect secondary to TRAM flap. The separation was done in the following stages: stage 1—anterior rectus sheath and stage 2—external oblique muscles. From the 12 patients, three presented early complications: seroma (n = 2) and epitheliolysis (n = 1). There were no recurrences or other late complications (48 months follow-up period). The separation of the anterior rectus sheath, and incision in the lateral recess to undermine the oblique muscles, allowed the treatment of abdominal wall defects, without late complications.

Outcomes after Ventral Hernia Repair Using the Rives-Stoppa, Endoscopic, and Open Component Separation Techniques

Complex ventral hernias remain a challenge for general surgeons despite advances in minimally invasive surgical techniques. This study compares outcomes following Rives-Stoppa (RS) repair, components separation technique with mesh (CST-M) or without mesh (CST), and endoscopic components separation technique (ECST). A retrospective review of patients undergoing open ventral hernia repair between 2006 and 2011 was performed. Analysis included patient demographics, surgical site occurrences, hernia recurrence, hospital readmission, and mortality. The search was limited to open repairs, specifically the RS, CST-M, CST, and ECST with mesh techniques. A total of 362 patients underwent repair with RS (66), CST-M (126), CST (117), or ECST (53). The groups were demographically similar. ECST was more frequently used for patients with a history of two or more recurrences ( P < 0.001). The RS method had the lowest rate of recurrence (9.1%) compared with CST and CST-M with 28 and 25 per cent recurrences, respectively ( P = 0.011). The RS recurrence rate was not significantly different than ECST (15%). There were no significant differences between groups for surgical site occurrences ( P = 0.305), hospital read-mission ( P = 0.288), or death ( P = 0.197). When components separation is necessary for complex ventral hernia repair, ECST is a viable option without added morbidity or mortality.