Endoscopically Assisted ???Components Separation??? for Closure of Abdominal Wall Defects

Abstract

The repair of ventral hernia defects of the abdominal wall challenges both general and plastic surgeons. Ventral herniation is a postoperative complication in 10 percent of abdominal surgeries; the repair of such defects has a recurrence rate as high as 50 percent. The "components separation" technique has successfully decreased the recurrence rates of ventral abdominal hernias. However, this technique has been associated with midline dehiscence and a prolonged postoperative stay at the authors' institutions. The purpose of this study was to determine whether endoscopically assisted components separation could minimize operative damage to the vasculature of the abdominal wall and decrease postoperative wound dehiscence. The study group consisted of seven patients who underwent endoscopically assisted components separation; the control group consisted of 30 patients who underwent open components separation. The two groups were similar regarding demographic data and defect size. The endoscopic group had a higher initial success rate than the open group (100 versus 77 percent). Recurrence rates were not significantly different between the two groups. However, the endoscopically assisted components separation patients had fewer postoperative and long-term complications. In the authors' experience, endoscopically assisted components separation has proved to be a safe and effective method for the repair of complicated and recurrent midline ventral hernias.

Complex Abdominal Wall Reconstruction: A Comparison of Flap and Mesh Closure

“…15 Careful evaluation of the patient who presents with a complex abdominal defect reveals predisposing factors for herniation, including inadequate local fascial and muscular layers due to prior tissue loss; muscle denervation or vascular insufficiency due to prior irradiation or infection; wound infection; obesity; chronic pulmonary disease; malnutrition; sepsis; anemia; corticosteroid dependency; and/or concurrent malignant process. [15][16][17][18] All patients in this series demonstrated one or more risk factors that predispose to problems with abdominal closure. Indeed, 49% of the patients with an incisional hernia had already failed at least one prior attempt at abdominal wall reconstruction.…”

Open versus endoscopic component separation: a cost comparison

“…However, major wound morbidity may ensue from the large lipocutaneous skin flaps [1]. With advances in minimally invasive surgery, endoscopic approaches have been described and proposed as alternatives to minimize wound flap morbidity [2][3][4][5].Although some studies have investigated the clinical outcomes associated with open and endoscopic component separation, none have evaluated the costs associated with these procedures in the setting of complex abdominal wall reconstruction. It is unclear whether the additional cost of…”

Laparoscopic Ventral Hernia Repair

“…19,20 Once the laparoscopic device is used to create a space between the external and internal oblique muscles, the location of the camera can be determined according to the use of laparoscopic component separation technique only or the performance of complete laparoscopic ventral hernia repair. The semilunar line is located where the external oblique muscle and the rectus abdominis muscle meet.…”