Open Component Separation for Abdominal Wall Reconstruction
Open component separation can be described by a variety of techniques. The most commonly utilized technique involves detaching the insertion of the external oblique along its length lateral to the rectus abdominis muscles and separating the external oblique muscle from the internal oblique. This may be accomplished with or without the mobilization of the posterior rectus sheath and with or without the use of a prosthesis. Primary closure of the midline (posterior and anterior rectus sheaths) should be performed using a short suture technique in which 5–8-mm bites of tissue are taken with each bite in terms of both depth and travel, taking care to avoid incorporating muscle and attenuated fascia within the suture line. This technique should be used selectively for patients with medium to large defects. The benefits of component separation performed in this manner are twofold: (1) medial mobilization of the rectus muscles and (2) reduced postoperative tension on the midline closure. Recurrence rates in the 5–20% range should be expected, and recurrences are typically smaller and easier to deal with compared to the hernia at the time of reconstruction with CS. A perforator-sparing technique is best when possible and should yield wound complication rates that should be less than 10% and generally minor in severity.
KeywordsOpen component separation Abdominal wall reconstruction Ventral hernia