Original concepts in anatomy, abdominal-wall surgery, and component separation technique and strategy.

Publisher: Springer Country of Publication: France NLM ID: 9715168 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1248-9204 (Electronic) Linking ISSN: 12489204 NLM ISO Abbreviation: Hernia Subsets: MEDLINE

Original Publication: Paris, France : Springer, c1997-

Surgical Mesh*; Abdominal Muscles/*surgery ; Hernia, Ventral/*surgery ; Herniorrhaphy/*methods ; Incisional Hernia/*surgery; Abdominal Muscles/anatomy & histology ; Abdominal Wall/anatomy & histology ; Abdominal Wall/surgery ; Adult ; Aged ; Aged, 80 and over ; Dissection ; Fascia ; Humans ; Middle Aged ; Plastic Surgery Procedures/methods

Background: The abdominal wall can be considered comprised of two compartments: an anterior and a posterior compartment. The anterior compartment includes the anterior rectus sheath and the rectus muscle. The posterior compartment comprises the posterior rectus sheath, the transversalis fascia, and the peritoneum. When a large defect in the anterior compartment has to be corrected, for example, a rectus diastasis or large incisional hernia, an action on the anterior compartment is necessary; therefore, an anterior component separation has to be considered. If a loss of substance is present in the posterior compartment, a trasversus abdominis release should be accomplished.
Methods: We propose an original anterior compartment mobilisation, by a posterior approach. Dissection of the posterior rectus sheet proceeds until the linea semilunaris is reached. Incision of the anterior rectus sheath permits a mobilisation of the anterior compartment by a posterior approach. A mesh is placed in a sublay position. If the abdominal wall presents a loss of substance of the posterior compartment, a transversus abdominis release (TAR) can be performed in the same time.
Results: No hernia recurrences, no wound infection, and no mesh infection have been reported.
Conclusions: The anterior compartment mobilization permits mobilization towards the midline of rectus muscle and restoration of anterior compartment, with low morbidity rate; it can be easily associated to a large sublay mesh placement, it allows the preservation of the neurovascular bundles and rectus muscle trophism, and it can be associated with a concomitant TAR procedure for the restoration of the PC, if necessary.

Comment in: Hernia. 2024 Jun;28(3):939-940. doi: 10.1007/s10029-023-02958-x. (PMID: 38197894)

Di Bello JN, Moore JH (1996) Sliding myofascial flap of the rectus abdominus muscles for the closure of recurrent ventral hernias. Plast Reconstr Surg 98(3):464–469. (PMID: 10.1097/00006534-199609000-00016)
Ramirez OM, Ruas E, Dellon AL (1990) “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 86(3):519–526. (PMID: 10.1097/00006534-199009000-00023)
Saulis AS, Dumanian GA (2002) Periumbilical rectus abdominis perforator preservation significantly reduces superficial wound complications in “separation of parts” hernia repairs. Plast Reconstr Surg 109(7):2275–2280. (PMID: 10.1097/00006534-200206000-00016)
Rosen MJ, Jin J, McGee MF et al (2007) Laparoscopic component separation in the single-stage treatment of infected abdominal wall prosthetic removal. Hernia 11:435–440. (PMID: 10.1007/s10029-007-0255-y)
Daes J (2014) Endoscopic subcutaneous approach to component separation. J Am Col Surg 218:e1–e4. (PMID: 10.1016/j.jamcollsurg.2013.09.020)
Rosen MJ (2017) Posterior component separation with transversus abdominis muscle release. In: Rosen MJ (ed) Atlas of abdominal wall reconstruction, 2nd edn. Elsevier, Philadelphia, pp 82–109.
Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ (2012) Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg 204(5):709e716. (PMID: 10.1016/j.amjsurg.2012.02.008)
Campanelli G, Trivellini G et al (2002) Surgical treatment of incisional hernias with marked loss of substance. Hernia 4(4):202–205. (PMID: 10.1007/BF01201067)
Camapnelli G, Catena F, Ansaloni L (2008) Prosthetic abdominal wall hernia repair in emergency surgery. WJES 3:33.
Stoppa RE (1989) The treatment of complicated groin and incisional hernias. World J Surg 13:545–554. (PMID: 10.1007/BF01658869)
van Geffen HJ, Simmermacher RK, van Vroonhoven TJ et al (2005) Surgical treatment of large contaminated abdominal wall defects. J Am Coll Surg 201(2):206–212. (PMID: 10.1016/j.jamcollsurg.2005.03.030)
Cox TC, Pearl JP, Ritter EM (2010) Rives-Stoppa incisional hernia repair combined with laparoscopic separation of abdominal wall components: a novel approach to complex abdominal wall closure Hernia. J Hernias Abdom Wall Surg 14(6):561e567.
Giurgius M, Bendure L, Davenport DL, Roth JS (2012) The endoscopic component separation technique for hernia repair results in reduced morbidity compared to the open component separation technique Hernia. J Hernias Abdom Wall Surg 16(1):47e51.
Bachman SL, Ramaswamy A, Ramshaw BJ (2009) Early results of midline hernia repair using a minimally invasive component separation technique. Am Surg 75(7):572e577.
Netter F (2018) Atlas of human anatomy, 6 edn, plate 248. s.l. Elsevier—Health Sciences Division, Amsterdam, ISBN 9780323390095.

Keywords: Anterior compartment mobilisation; Anterior component separation; Loss of substance; Posterior component separation; Rectus diastasis

Date Created: 20190908 Date Completed: 20210420 Latest Revision: 20241011

20250114

10.1007/s10029-019-02030-7

31493052