Posterior component separation with transversus abdominis release successfully addresses recurrent ventral hernias following anterior component separation

Pauli, Eric M.; Wang, J.; Petro, Clayton C.; Juza, Ryan M.; Novitsky, Yuri W.; Rosen, Michael J.

doi:10.1007/s10029-014-1331-8

Cited by 112 publications

(42 citation statements)

References 18 publications

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“…A partitional technique involving component separation and fascia-fascia closure has both high risk of short term post-operative complications, as well as a long operative time [11]. Open ventral hernia repair with component separation is appropriate for complex hernias, not simply hernias in patients with infection or other relatively simple problems [12]. Staging of the ventral hernia has been helpful in surgical decision and in post-operative comparison of results [13].…”

Section: Discussionmentioning

confidence: 99%

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Component Separation or Mesh Repair for Ventral Hernia Repair - The Role of Mesh in Covering all the Abdominal Wall in the Component Repair

Frezza¹

2017

GHR

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Simple repair of the hernia opening, Ventral Hernia Repair (VHR) has been confronted by a more definitive goal of restoration of abdominal muscular strength and wall function accomplished by mobilizing abdominal wall muscles and closing with inlay mesh, Component Separation Repair (CSR). Our observation was based on the notion that shear forces cause herniation and therefore that is an affliction of the entire abdominal wall, not a localized event. We took that information and we compare a series of VHR patients with a series of CSR patients would provision evidence to improve the relative value of the techniques.Material: Retrospective comparison of 30 consecutive CSR patients and 30 consecutive VHR patients was obtained. All abdominal wall hernia defects were at least 10 cm 2 in size. T tests with unequal variances were used to evaluate differences in means of continuous variables and to estimate 95% confidence intervals of differences.Results: Although CSR patients were older, had higher BMI's and higher ASA scores than did VHR patients, the odds of recurrence for CSR patients were less than for VHR patients (P<0.0001). Differences in respects to ileus and wound complications, while they favored CSR patients, might have been due to chance (P>0.05 for each analysis). In VHR group 11 patients required CSR after 9-24 months, 14 patients have prolonged ileus. In the CSR group two patients were reoperated for removal of midline skin changes, two for severe seromas requiring wash up of the subcutaneous and fascia area and placement of a wound vacuum on top of the mesh. Conclusion:This study supports the notion that a ventral hernia reflects a defect in the abdominal wall not just the point at which the hernia forms. To avoid a point of rupture, we support highly the CSR technique, since hernia is an abdominal disease not just a hole.

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Section: Discussionmentioning

confidence: 99%

“…Component graph separation, used to correct large ventral hernias, can yields complications in few patients but this was also an early paper where this surgery was done in complicated cases [24,25]. Posterior repair have been showed similar results, if not better overall [12,26].…”

Section: Discussionmentioning

confidence: 99%

Component Separation or Mesh Repair for Ventral Hernia Repair - The Role of Mesh in Covering all the Abdominal Wall in the Component Repair

Frezza¹

2017

GHR

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“…Complicated hernias with loss of domain inspired the development of the transversus abdominis release technique (TAR), which Pauli et al. reported in 2015 . This technique provides significant mobilization of the posterior rectus sheath with extensive lateral dissection between the transversus abdominis and either the transversalis fascia or the peritoneum, with preservation of the neurovascular bundle.…”

Section: Component Separation Techniquesmentioning

confidence: 99%

Evolution of ventral hernia repair

Faylona

2017

Asian J Endoscop Surgery

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“…Short term recurrence though between the open and the laparoscopic technique is comparable [14][15][16][17][18]. Other surgeons, when faced with a ventral hernia choose between higher incidence recurrent repair or complication and it has been shown that the laparoscopic repair and the component separation are the two evolving strategies to repair the ventral hernia, one to repair the midline, as we said, and one to repair the whole abdominal wall [19][20][21][22].…”

Section: The Clinical Issuesmentioning

confidence: 99%

A Physic Tensile Forces Experiment to Possible Explain the Reason of Failing Ventral Hernia Repair

Frezza¹

2017

GHR

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IntroductionVentral Hernia Repair (VHR) has been a challenging surgery during years. Matters moved to mobilizing muscle and closing the abdominal wall. Component Separation Repair (CSR), which required dissection of the fascia of the rectus muscle and closure of the midline linea alba [1]. The goal of ventral hernia repair is to restore abdominal muscle strength and abdominal wall function [2,3]. The muscle component of the ventral hernia is one of many variables affecting the abdominal wall to contribute to ventral hernia. In this paper we focus on that issue understanding the complexity of the pathology. We hypothesized that evaluating the maximal stress on a set of artificial tensile structures, rubber bands, might open a different view on the effects of daily forces affecting the strength of varied abdominal walls. Materials and MethodsFour sets of six rubber bands were evaluated (Table 1).In the first comparison, we matched rubber band based on their thickness of 0.1x0.35 cm: A) short (4.2 cm), high strength rubber bands (red bands) (modeled the young person with much muscle strength and flexibility, B) long (7 cm), high strength rubber bands of longer length (white bands) modeled abdominal walls with fully stretched muscle, but with similar strength, such as occurs after pregnancy or with obesity. In the second comparison, we match the length (4.2 cm) and change the thickness: A) thick (0.1x0.35 cm), rubber bands (red bands) as above and C) thin (0.1x0.1 cm), rubber bands (yellow bands) modeled elderly or protein deficit patients, obese patient who had experienced an operation. We then use for final comparison a D) thin and short band (0.1x0.1x2 cm).Thickness, width and length of the bands were measured using a vernier caliper. The four bands were then stressed with progressively increasing weights at 20 g increments. Weight at the time of failure was recorded for each of six trials of each band type (Table 1).The Tensile strength was measured in force per cross-sectional area. All the data is reported and compared in table 1. The units of force were derived by multiplying mass (kg) by the acceleration of gravity (9.81 m/sec 2 ) per Newton's second law of motion (F=m x a). This results in a force unit of Newton. The tensile strength was measured by taking the weight (Newton) and dividing it by the cross-sectional area (cm 2 ). Tension and shear forces were summarized to create the condition to apply the log regression (Tables 2 and 3). Ventral hernia repair, a challenging procedure. We consider rubber bands, evaluating the strength of bands of differing length and thickness to see how changes in these parameters affect the elastic materials to try to mimic how abdominal muscle get affected by tensile forces.

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Posterior component separation with transversus abdominis release successfully addresses recurrent ventral hernias following anterior component separation

Abstract: Patients with a history of an ACS who develop a recurrence represent a challenging clinical scenario with limited options for surgical repair. A PCS/TAR hernia repair achieves acceptable outcomes and may in fact be the best approach available.

Cited by 112 publications

References 18 publications

Component Separation or Mesh Repair for Ventral Hernia Repair - The Role of Mesh in Covering all the Abdominal Wall in the Component Repair

Component Separation or Mesh Repair for Ventral Hernia Repair - The Role of Mesh in Covering all the Abdominal Wall in the Component Repair

Evolution of ventral hernia repair

A Physic Tensile Forces Experiment to Possible Explain the Reason of Failing Ventral Hernia Repair

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