Component Separation: Options and Techniques

  • Ivy N. Haskins
  • Michael J. Rosen


The management of large abdominal wall defects remains clinically challenging. The adoption of the component separation technique has facilitated complex abdominal wall reconstruction with autologous abdominal wall tissue. Herein, we detail the current separation of component techniques as well as the advantages and disadvantages of each surgical technique.


Anterior component separation Complex abdominal wall reconstruction Loss of domain Minimally invasive component separation Posterior component separation Separation of components 


  1. 1.
    DiBello JN, Moore JH. Sliding myofascial flap of the rectus abdominus muscles for the closure of recurrent ventral hernias. Plast Reconstr Surg. 1996;98(3):464–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Ramirez OM, Ruas E, Dellon AL. “Components Separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg. 1990;86(3):519–26.CrossRefPubMedGoogle Scholar
  3. 3.
    Wong CH, Lin CH, Fu B, et al. Reconstruction of complex abdominal wall defect with free flaps: indications and clinical outcome. Plast Reconstr Surg. 2009;124(2):500–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Williams JK, Carlson GW, deChalian T, et al. Role of tensor fasciae latae in abdominal wall reconstruction. Plast Reconstr Surg. 1998;101(3):713–8.CrossRefPubMedGoogle Scholar
  5. 5.
    de Vries Reilingh TS, Bodegom ME, van Goor H, et al. Autologous tissue repair of large abdominal wall defects. Br J Surg. 2007;94(7):791–803.CrossRefPubMedGoogle Scholar
  6. 6.
    Blatnik J, Jin J, Rosen M. Abdominal hernia repair with bridging acellular dermal matrix—an expensive hernia sac. Am J Surg. 2008;196(1):47–50.CrossRefPubMedGoogle Scholar
  7. 7.
    LeBlanc K. Proper mesh overlap is a key determinant in hernia recurrence following laparoscopic ventral and incisional hernia repair. Hernia. 2016;20(1):85–99.CrossRefPubMedGoogle Scholar
  8. 8.
    Anthony T, Bergen PC, Kim LT, et al. Factors affecting recurrence following incisional herniorrhaphy. World J Surg. 2000;24(1):95–100.CrossRefPubMedGoogle Scholar
  9. 9.
    Rosen MJ, Jin J, McGee MF, et al. Laparoscopic component separation in the single-stage treatment of infected abdominal wall prosthetic removal. Hernia. 2007;11:435–40.CrossRefPubMedGoogle Scholar
  10. 10.
    van Geffen HJ, Simmermacher RK, van Vroonhoven TJ, et al. Surgical treatment of large contaminated abdominal wall defects. J Am Coll Surg. 2005;201(2):206–12.CrossRefPubMedGoogle Scholar
  11. 11.
    Krpata DM, Blatnik JA, Novitsky YW, et al. Posterior and open anterior components separations: a comparative analysis. Am J Surg. 2012;203(3):318–22.CrossRefPubMedGoogle Scholar
  12. 12.
    Hultman CS, Tong WM, Kittinger BJ, et al. Management of recurrent hernia after components separation: 10-year experience with abdominal wall reconstruction at an academic medical center. Ann Plast Surg. 2011;66(5):504–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Jin J, Rosen MJ, Blatnik J, et al. Use of acellular dermal matrix for complicated ventral hernia repair: dose technique affect outcomes? J Am Coll Surg. 2007;205(5):654–60.CrossRefPubMedGoogle Scholar
  14. 14.
    Finan KR, Vick CC, Kiefe CI, et al. Predictors of wound infection in ventral hernia repair. Am J Surg. 2005;190:676–81.CrossRefPubMedGoogle Scholar
  15. 15.
    Saulis AS, Dumanian GA. Periumbilical rectus abdominis perforator preservation significantly reduces superficial wound complications in “Separation of Parts” hernia repairs. Plast Reconstr Surg. 2002;109(7):2275–80.CrossRefPubMedGoogle Scholar
  16. 16.
    Holihan JL, Askenasy EP, Greenberg JA, et al. Component separation vs. bridged repair for large ventral hernias: a multi-institutional risk-adjusted comparison, systematic review, and meta-analysis. Surg Infect. 2016;17(1):17–26.CrossRefGoogle Scholar
  17. 17.
    Harth KC, Rosen MJ. Endoscopic versus open component separation in complex abdominal wall reconstruction. Am J Surg. 2010;199:342–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Holihan JL, Alawadi ZM, Harris JW, et al. Ventral hernia: patient selection, treatment, and management. Curr Probl Surg. 2016;53(7):307–54.CrossRefPubMedGoogle Scholar
  19. 19.
    Maas SM, de Vries Reilingh TS, van Goor H, et al. Endoscopically assisted “Components Separation Technique” for the repair of complicated ventral hernias. J Am Coll Surg. 2002;194(3):388–90.CrossRefPubMedGoogle Scholar
  20. 20.
    Jensen KK, Henriksen NA, Jorgensen LN. Endoscopic component separation for ventral hernia causes fewer wound complications compared to open components separation: a systematic review and meta-analysis. Surg Endosc. 2014;28:3046–52.CrossRefPubMedGoogle Scholar
  21. 21.
    Rosen MJ. Posterior component separation with transversus abdominis muscle release. In: Rosen MJ, editor. Atlas of abdominal wall reconstruction. 2nd ed. Philadelphia, PA: Elsevier; 2017. p. 82–109.Google Scholar
  22. 22.
    Blatnik JA, Krpata DM, Novitsky YW. Transversus abdominis release as an alternative component separation technique for ventral hernia repair. JAMA Surg. 2016;151(4):383–4.CrossRefPubMedGoogle Scholar
  23. 23.
    Mole JL, Bird ML, Fell JW. The effect of transversus abdominis activation on exercise-related transient abdominal pain. J Sci Med Sport. 2014;17:261–5.CrossRefPubMedGoogle Scholar
  24. 24.
    Hodges PW, Richardson CA. Inefficient muscular stabilization of the lumbar spine associated with low back pain: a motor control evaluation of transversus abdominis. Spine. 1996;21:2640–50.CrossRefPubMedGoogle Scholar
  25. 25.
    Faries M, Greenwood M. Core training: stabilizing the confusion. Strength Cond J. 2007;29:10–25.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Ivy N. Haskins
    • 1
  • Michael J. Rosen
    • 1
  1. 1.Comprehensive Hernia Center, Digestive Disease and Surgery InstituteCleveland Clinic FoundationClevelandUSA

Personalised recommendations