Incisional hernia repair by fascial component separation: results in 128 cases and evolution of technique

Endoscopic versus open component separation: systematic review and meta-analysis

“…We systematically reviewed each study according to the following criteria: (1) There were no study format restrictions for the systematic review, but the meta-analysis contained only controlled studies; (2) Involved either open or minimally invasive component separation or both; (3) The study report at least one of the desired wound complication outcome mentioned below; (4) Enrolled at least 5 patients; (5) Studies that involved significant variations in the open or minimally invasive technique, as determined by the two reviewers or third party adjudicators were also excluded.…”

“…Specifically, ligating a significant proportion of the perforating abdominal wall blood vessels predisposes the flap to ischemia and infection, in addition to potential formation of hematomas and seromas in the dead space [3,4]. Wound infections rates have been shown to range from 25 to 57 % [4][5][6][7].…”

“…Bilateral incisions are made at the medial insertion of the external oblique aponeurosis to the rectus sheath, an endoscopic balloon insufflator then separates the avascular plane between the external oblique and the internal oblique, and the external oblique is transected from pubic symphysis to costal margin using an endoscope. ECST has been suggested in preliminary studies to reduce wound complication rates post-operatively [4,5]. To date, there has not been a systematic review and subsequent metaanalysis to critically assess the effectiveness of endoscopic compared to the classic open component separation.…”

Repair of giant abdominal incisional hernia: our technique

“…Lateral skin flaps are created bilaterally up to the anterior axillary lines, exposing the rectus sheath and external oblique musculature along the length (Fig 2). 2,3 Both recti are opened at the medial border, exposing the rectus abdominis muscles, which are dissected off the posterior sheath. The hernial sac is replaced intra-abdominally and an appropriate large synthetic mesh is placed on the posterior sheath and fixed with continuous 2/0 polypropylene stitches (Fig 3).…”

Abdominal wall component release is a sensible choice for patients requiring complicated closure of abdominal defects

“…Previously, it has been reported that hernia recurrence rates using components separation technique range from 9% to 30%, depending on a number of patient risk factors, skill of the surgeon, and size of the hernia [39][40][41]. A review of the literature for open mesh repair suggests similar outcomes.…”