This study aims to compare the outcomes of posterior component separation and transversus abdominis release (PCSTAR) with the open anterior component separation (OACS) technique. OACS, first described by Ramirez et al. (Plast Reconstr Surg 86(3):519–526, 1990), has become an established technique for local myofascial advancement in abdominal hernia surgery. PCSTAR, described by Novitsky et al. (Am J Surg 204(5):709–716, 2012), is being used more frequently and is rapidly becoming the technique of choice in complex ventral hernia repair.
Analysis was conducted according to PRISMA guidelines. A systematic search of the MEDLINE, EMBASE and Pubmed databases was performed. Studies reporting exclusively on midline ventral hernia repair were reviewed. Studies describing PCSTAR were selected and compared to matched studies describing OACS. Meta-analysis was used to compare outcomes between the two-pooled groups.
Seven studies describing 281 cases of PCSTAR for midline incisional hernia using a retromuscular mesh placement were identified. Six comparable studies describing 285 cases of OACS and retromuscular mesh placement were identified from the same search. Pooled analysis demonstrated a hernia recurrence rate of 5.7% (3.0–8.5) for PCSTAR and 9.5% (4.0–14.9) for OACS. Comparative analysis demonstrated no significant difference between hernia recurrence rate (p = 0.23). The use of bridging mesh was not significantly reduced by the use of PCSTAR (3.1%) when compared to ACS (7.5%) (p = 0.22). No significant difference was found in wound complication rates between PCSTAR and OACS, respectively, ‘superficial’ 10.9 vs 21.6% (p = 0.15); and ‘deep’ 9.5 vs 12.7% (p = 0.53).
These data suggest PCSTAR have comparable outcomes to OACS. This analysis is limited by the lack of comparative studies and heterogenicity in the OACS group.
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Nil related to current review.
Conflict of interest
JDH declares no conflict of interest; CAL declares no conflict of interest; YM declares no conflict of interest related to the submitted work and declares personal fees from Medtronic and Astellas; PB declares no conflict of interest; SO declares no conflict of interest; CV declares no conflict of interest directly related to the current work and declares consultancy advisor to Acelity and paid lecture for Allergan; JW declares no conflict of interest.
This study did not need approval from an ethic committee.
Human and animal rights
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent was not required for this type of study.
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Hodgkinson, J.D., Leo, C.A., Maeda, Y. et al. A meta-analysis comparing open anterior component separation with posterior component separation and transversus abdominis release in the repair of midline ventral hernias. Hernia 22, 617–626 (2018). https://doi.org/10.1007/s10029-018-1757-5
- Abdominal wall reconstruction
- Anterior component separation
- Posterior component separation
- Transversus abdominis release