Original concepts in anatomy, abdominal-wall surgery, and component separation technique and strategy
- 106 Downloads
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.
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.
No hernia recurrences, no wound infection, and no mesh infection have been reported.
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.
KeywordsRectus diastasis Loss of substance Anterior component separation Posterior component separation Anterior compartment mobilisation
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Human and animal rights
This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
- 6.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 82–109Google Scholar
- 9.Camapnelli G, Catena F, Ansaloni L (2008) Prosthetic abdominal wall hernia repair in emergency surgery. WJES 3:33Google Scholar
- 12.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):561e567Google Scholar
- 13.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):47e51Google Scholar
- 14.Bachman SL, Ramaswamy A, Ramshaw BJ (2009) Early results of midline hernia repair using a minimally invasive component separation technique. Am Surg 75(7):572e577Google Scholar
- 15.Netter F (2018) Atlas of human anatomy, 6 edn, plate 248. s.l. Elsevier—Health Sciences Division, Amsterdam, ISBN 9780323390095Google Scholar