Abstract
The introduction of the anterior component separation operation has facilitated our ability to close complex defects of the anterior abdominal wall. This classic operation was first described by Ramirez et al. in 1990 and has revolutionized hernia repair. With the evolution of hernia repair techniques, the use of mesh to further support the repair has demonstrated success. This mesh can be biologic, synthetic, or resorbable and can be placed in various layers that include onlay, underlay, retrorectus, as well as fascial interposition/bridge. The anterior component separation can also be performed as a minimally invasive technique or laparoscopically. Another recently described method is the “sandwich” technique whereby a classic component separation is performed followed by bilaminar mesh reinforcement as an underlay/retrorectus and onlay (Morris and LeBlanc, Hernia 17:45–51, 2013). This chapter will include a description of the various types of component separation repairs with an emphasis on outcomes and complications.
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References
Ramirez OM, Ruas E, Dellon AL. Components separation method for closure of abdominal was defects: an anatomic and clinical study. Plast Reconstr Surg. 1990;86(3):519–26.
Shestak KC, Edington HJD, Johnson RR. The separation of anatomic components technique for the reconstruction of massive midline abdominal wall defects: anatomy, surgical technique, applications, and limitations revisited. Plast Reconstr Surg. 2000;105:731.
Luijendijk RW, Hop WC, van den Tol MP, et al. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med. 2000;343(6):392–8.
Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg. 2004;240(4):578–83.
Morris LM, LeBlanc KA. Components separation technique utilizing an intraperitoneal biologic and an onlay lightweight polypropylene mesh: “a sandwich technique”. Hernia. 2013;17:45–51.
Ko JH, Wang EC, Salvay DM, Paul BC, Dumanian GA. Abdominal wall reconstruction: lessons learned from 200 “components separation” procedures. Arch Surg. 2009;144(11):1047–55.
Holihan J, Askenasy E, Greenberg J, et al. Component separation versus bridged repair for large ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery. 2010;148:544–58.
Holihan J, Askenasy E, Greenberg J, et al. Component separation versus bridged repair for large ventral hernias: a multi-institutional risk-adjusted comparison, systematic review, and meta-analysis. Surg Infect. 2015;17(1):17–26.
Franklin BR, Patel KM, Nahabedian MY, Baldassari LE, Cohen EI, Bhanot P. Predicting abdominal closure after component separation for complex ventral hernia: maximizing the use of preoperative computed tomography. Ann Plast Surg. 2013;71:261–5.
Blair LJ, Ross SW, Huntington CR, et al. Computed tomographic measurements predict component separation in ventral hernia repair. J Surg Res. 2015;199(2):420–7.
Patel KM, Bhanot P, Franklin B, Albino F, Nahabedian MY. Use of intraoperative indocyanine-green angiography to minimize wound-healing complications in abdominal wall reconstruction. J Plast Surg Hand Surg. 2013;47(6):476–80.
Singh DP, Silverman RP. Open component separation. In: Nahabedian M, Bhanot P, editors. Abdominal wall reconstruction. Woodbury, CT: CineMed; 2014. p. 111–8.
Stigal K, Roth JS. Anterior component separation techniques. In: Hope WH, Cobb WS, Adrales GL, editors. Textbook of hernia. Cham: Springer; 2017. p. 233–42.
Butler CE, Campbell KT. Minimally invasive component separation with inlay bioprosthetic mesh (MICSIB) for complex abdominal wall reconstruction. Plast Reconstr Surg. 2011;128:698–709.
Ghali S, Turza KC, Bauman DP, Butler CE. Minimally invasive component separation results in fewer wound-healing complications than open component separation for large ventral hernia repairs. J Am Coll Surg. 2012;214(6):981–9.
Saulis A, Dumanian G. Periumbilical rectus abdominis perforator preservation significantly reduces superficial wound complications in “separation of parts” hernia repairs. Plast Reconstr Surg. 2002;109:2275–80.
Albino F, Patel KM, Bhanot P, Nahabedian MY. Does mesh location matter in abdominal wall reconstruction? A systematic review of the literature and a summary of recommendations. Plast Reconstr Surg. 2013;132:1295–304.
Torregrossa-Gallud A, Sancho Muriell J, Bueno-Lledo J, et al. Modified components separation technique: experience treating large, complex ventral hernias at a University Hospital. Hernia. 2017;21:601–8.
Girotto JA, Ko MJ, Redett R, et al. Closure of chronic abdominal wall defects: a long-term evaluation of the components separation method. Ann Plast Surg. 1999;42:385–95.
Girotto JA, Chiaramonte M, Menon NG, Singh NK, Silverman R, Tufaro AP, Nahabedian MY, Goldberg NH, Manson PN. Recalcitrant abdominal wall hernias: long-term superiority of autologous tissue repair. Plast Reconstr Surg. 2003;112:106.
Nahabedian MY. Does AlloDerm stretch? Plast Reconstr Surg. 2007;120:1276–80.
Garvey PG, Giordano SA, Baumann DP, Liu J, Butler CE. Long-term outcomes after abdominal wall reconstruction with acellular dermal matrix. J Am Coll Surg. 2017;224:341–50.
De Vries TS, van Goor H, Rosman C, et al. “Components separation technique” for the repair of large abdominal wall hernias. J Am Coll Surg. 2003;196:32–7.
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© 2019 Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)
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Nahabedian, M.Y. (2019). Component Separation: Outcomes and Complications. In: Davis, Jr., S., Dakin, G., Bates, A. (eds) The SAGES Manual of Hernia Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-78411-3_21
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DOI: https://doi.org/10.1007/978-3-319-78411-3_21
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