The Component Separation Technique for Hernia Repair: A Comparison of Open and Endoscopic Techniques

Abstract

The open components separation technique (CST) for hernia repair allows for autologous tissue repair with approximation of the midline fascia in patients with complex hernias. CST requires creation of large undermining skin flaps, whereas the endoscopic component separation technique (ECST) is performed without division of the epigastric perforating vessels and may minimize wound morbidity. A review of patient demographics and outcome measures of patients undergoing CST and ECST between November 2008 and February 2010 was performed. Twenty-five patients were identified who underwent either CST (14 patients) or ECST (11 patients). There were no differences in body mass index (CST 34.8 kg/m2, ECST 37.5 kg/m2, P = 0.45), operating room times (CST 268 minutes, ECST 252 minutes, P = 0.54), or hospital length of stay (CST 5 days, ECST 5.8 days, P = 0.78). Wound complications occurred less with ECST (9 vs 57%, P = 0.03). The time to resolution of wound complications in ECST was reduced * 1 vs 4 months). No recurrences were seen in either group with a mean follow-up of 4months (range, 1 to 12 months). ECST and CST require similar operative times and hospital lengths of stay. ECST is associated with reduced wound complications compared with CST. Short-term recurrence rates with CST and ECST are comparable.

Component Separation vs. Bridged Repair for Large Ventral Hernias: A Multi-Institutional Risk-Adjusted Comparison, Systematic Review, and Meta-Analysis

“…On pairwise meta-analysis, primary fascial closure was associated with lower odds of SSO and recurrence than bridged repair (Table 4) [23][24][25][26][27][28]. The heterogeneity p value was 0.229 for SSO, indicating no statistically significant heterogeneity; however, the heterogeneity p value for recurrence was 0.012, suggesting heterogeneity of the studies.…”

Conventional versus endoscopic components separation technique: New anthropometric calculation for selection of surgical approach

“…Some of the results are case presentations and some are technical discussions; studies related to this new technique are still very scarce. As in our study, 8 studies in the literature survey compared conventional and endoscopic CST in treating uncommon GVIHs [15,[20][21][22][23][24][25][26]. One is a study that mainly emphasizes both methods in terms of cost [25].…”

“…Both groups were also compared in terms of postoperative complications; there was no statistically significant difference between them (P = 0.656). Many studies have reported that the greatest advantage of the endoscopic method compared with the conventional method is a reduction in postoperative complications, especially related to the wound site [15,20,[22][23][24][25][26], but Azoury et al found no significant difference in postoperative complications between the methods. We also did not find this advantage of the endoscopic procedure to be statistically significant in our study.…”

Abdominal Wall Reconstruction: The Rise of Endoscopic Component Separation

“…There was a significantly higher rate of contaminated or infected wounds in the open group of Giurgius et al [18] (33% vs. 5%, p=.03). Albright et al [16] also contained a much higher percentage of contaminated cases in the open group although this result was not statistically significant (35.7% vs. 9.1%, p=NS). A subgroup analysis was performed by both authors for patients with only clean wounds in each group.…”

“…A major issue with open component separation is its high wound complication rate [6][7][8][9]. All studies comparing open to endoscopic component separation demonstrated a trend toward decreased wound complications in the endoscopic group [14][15][16][17][18], although only two, Albright et al [16] and Giurgius et al [18], were able to achieve statistical significance. In both studies, patients were not adequately matched in terms of preoperative wound contamination.…”