Advertisement

Hernia Surgery pp 137-147 | Cite as

Open Anterior Component Separation

  • Peter ThompsonEmail author
  • Albert Losken
Chapter

Abstract

Since its original description in 1990, the anterior components separation technique for reconstruction of large and complex abdominal wall defects has evolved as an elegant and indispensible tool for surgeons across specialties. In contrast to historically used techniques which often involved placement of a large piece of spanning synthetic mesh to cover hernia defects, separation of components recreates the native physiology of the abdominal wall by restoring the normal anatomic relationship of the bilateral rectus sheaths. Refinements to Ramirez’s originally described procedure include mesh reinforcement of midline closure and minimal dissection techniques, which spare musculocutaneous perforators in the periumbilical region. Discussion among experts continues regarding the optimal type of mesh, position of mesh placement, and role of endoscopic and other minimally invasive methods for flap dissection. Herein the authors discuss these trends and controversies, and describe their personal technique and algorithm for application of the anterior components separation method.

Keywords

Anterior component separation Myofascial flap advancement Abdominal wall reconstruction Ventral hernia Incisional hernia Biologic mesh Synthetic mesh Technique Periumbilical perforator Algorithm 

References

  1. 1.
    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
  2. 2.
    Gibson CL. Post-operative intestinal obstruction. Ann Surg. 1916;63(4):442–51.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Leber GE, Garb JL, Alexander AI, Reed WP. Long-term complications associated with prosthetic repair of incisional hernias. Arch Surg. 1998;133(4):378–82.CrossRefPubMedGoogle Scholar
  4. 4.
    de Vries Reilingh TS, van Geldere D, Langenhorst B, de Jong D, van der Wilt GJ, van Goor H, et al. Repair of large midline incisional hernias with polypropylene mesh: comparison of three operative techniques. Hernia. 2004;8(1):56–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Lichtenstein IL, Shore JM. Repair of recurrent ventral hernias by an internal “binder”. Am J Surg. 1976;132(1):121–5.CrossRefPubMedGoogle Scholar
  6. 6.
    Williams JK, Carlson GW, deChalain T, Howell R, Coleman JJ. Role of tensor fasciae latae in abdominal wall reconstruction. Plast Reconstr Surg. 1998;101(3):713–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Williams JK, Carlson GW, Howell RL, Wagner JD, Nahai F, Coleman JJ. The tensor fascia lata free flap in abdominal-wall reconstruction. J Reconstr Microsurg. 1997;13(2):83–90. discussion 90-81.CrossRefPubMedGoogle Scholar
  8. 8.
    de Vries Reilingh TS, van Goor H, Rosman C, Bemelmans MH, de Jong D, van Nieuwenhoven EJ, et al. “Components separation technique” for the repair of large abdominal wall hernias. J Am Coll Surg. 2003;196(1):32–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Lowe III JB, Lowe JB, Baty JD, Garza JR. Risks associated with “components separation” for closure of complex abdominal wall defects. Plast Reconstr Surg. 2003;111(3):1276–83. quiz 1284-1275; discussion 1286-1278.CrossRefPubMedGoogle Scholar
  10. 10.
    Maas SM, van Engeland M, Leeksma NG, Bleichrodt RP. A modification of the “components separation” technique for closure of abdominal wall defects in the presence of an enterostomy. J Am Coll Surg. 1999;189(1):138–40.CrossRefPubMedGoogle Scholar
  11. 11.
    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.CrossRefPubMedGoogle Scholar
  12. 12.
    Lowe JB, Garza JR, Bowman JL, Rohrich RJ, Strodel WE. Endoscopically assisted “components separation” for closure of abdominal wall defects. Plast Reconstr Surg. 2000;105(2):720–9. quiz 730.CrossRefPubMedGoogle Scholar
  13. 13.
    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. discussion 2281-2272.CrossRefPubMedGoogle Scholar
  14. 14.
    de Vries Reilingh TS, van Goor H, Charbon JA, Rosman C, Hesselink EJ, van der Wilt GJ, et al. Repair of giant midline abdominal wall hernias: “components separation technique” versus prosthetic repair: interim analysis of a randomized controlled trial. World J Surg. 2007;31(4):756–63.CrossRefPubMedGoogle Scholar
  15. 15.
    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. discussion 583-575.PubMedPubMedCentralGoogle Scholar
  16. 16.
    den Hartog D, Dur AH, Tuinebreijer WE, Kreis RW. Open surgical procedures for incisional hernias. Cochrane Database Syst Rev. 2008(3):CD006438.Google Scholar
  17. 17.
    Espinosa-de-los-Monteros A, de la Torre JI, Marrero I, Andrades P, Davis MR, Vasconez LO. Utilization of human cadaveric acellular dermis for abdominal hernia reconstruction. Ann Plast Surg. 2007;58(3):264–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Ko JH, Salvay DM, Paul BC, Wang EC, Dumanian GA. Soft polypropylene mesh, but not cadaveric dermis, significantly improves outcomes in midline hernia repairs using the components separation technique. Plast Reconstr Surg. 2009;124(3):836–47.CrossRefPubMedGoogle Scholar
  19. 19.
    Schuster R, Singh J, Safadi BY, Wren SM. The use of acellular dermal matrix for contaminated abdominal wall defects: wound status predicts success. Am J Surg. 2006;192(5):594–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Sailes FC, Walls J, Guelig D, Mirzabeigi M, Long WD, Crawford A, et al. Synthetic and biological mesh in component separation: a 10-year single institution review. Ann Plast Surg. 2010;64(5):696–8.PubMedGoogle Scholar
  21. 21.
    Pauli EM, Rosen MJ. Open ventral hernia repair with component separation. Surg Clin North Am. 2013;93(5):1111–33.CrossRefPubMedGoogle Scholar
  22. 22.
    Albino FP, Patel KM, Nahabedian MY, Sosin M, Attinger CE, Bhanot P. Does mesh location matter in abdominal wall reconstruction? A systematic review of the literature and a summary of recommendations. Plast Reconstr Surg. 2013;132(5):1295–304.CrossRefPubMedGoogle Scholar
  23. 23.
    Jernigan TW, Fabian TC, Croce MA, Moore N, Pritchard FE, Minard G, et al. Staged management of giant abdominal wall defects: acute and long-term results. Ann Surg. 2003;238(3):349–55. discussion 355-347.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Ghazi B, Deigni O, Yezhelyev M, Losken A. Current options in the management of complex abdominal wall defects. Ann Plast Surg. 2011;66(5):488–92.CrossRefPubMedGoogle Scholar
  25. 25.
    Holton III LH, Kim D, Silverman RP, Rodriguez ED, Singh N, Goldberg NH. Human acellular dermal matrix for repair of abdominal wall defects: review of clinical experience and experimental data. J Long Term Eff Med Implants. 2005;15(5):547–58.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Emory Division of Plastic and Reconstructive SurgeryEmory UniversityAtlantaUSA

Personalised recommendations