Changes in the abdominal wall after anterior, posterior, and combined component separation

Abstract Aim Effects of component separation (CS) on abdominal wall musculature have only been investigated in smaller case series. The study aimed to compare abdominal wall alterations following endoscopic anterior component separation (EACS) or transverse abdominis release (TAR). Material and Methods Computed tomography scans were evaluated in patients who underwent open ventral hernia repair with TAR or EACS. Lateral abdominal wall muscle thickness and displacement were compared with preoperative images after bilateral CS and the undivided side postoperatively after unilateral CS. Results In total, 105 patients were included. The mean defect width was 12.2 cm. Fifty-five (52%) and 15 (14%) underwent bilateral and unilateral EACS, respectively. Five (5%) and 14 (13%) underwent bilateral and unilateral TAR, respectively. Sixteen (15%) underwent unilateral EACS and contralateral TAR. Complete fascial closure was achieved in 103 (98%) patients. The external oblique and transverse abdominis muscles were significantly laterally displaced with a mean of 2.74 cm (95% CI 2.29-3.19 cm) and 0.82 cm (0.07-1.57 cm) after EACS and TAR, respectively. The combined thickness of the lateral muscles was significantly decreased after EACS (mean decrease 10.5% [5.8-15.6%]) and insignificantly decreased after TAR (mean decrease 2.6% [-4.8-9.5%]), mean reduction difference EACS versus TAR 0.22 cm (-0.01-0.46 cm). One (1%) patient developed an iatrogenic linea semilunaris hernia after EACS. The recurrence rate was 19% after mean 1.7 years follow-up. Conclusions The divided muscle was significantly more laterally displaced after EACS compared with TAR. The thickness of the lateral muscles was slightly decreased after EACS and unchanged after TAR.

Download Full-text

Prospective study of midline abdominal incisional hernia repair by component separation technique augmented with prosthetic mesh

International Surgery Journal ◽

10.18203/2349-2902.isj20204121 ◽

2020 ◽

Vol 7 (10) ◽

pp. 3273

Author(s):

Ravi Saroha ◽

Shivani B. Paruthy ◽

Sunil Singh

Keyword(s):

Abdominal Wall ◽

Tertiary Care ◽

Component Separation ◽

Separation Technique ◽

Close Monitoring ◽

Care Hospital ◽

Early Recovery ◽

Component Separation Technique ◽

Early Return ◽

Mesh Augmentation

Background: In our tertiary care hospital, we receive a large number of acute abdomen cases. Raised intra-abdominal pressure (IAP) makes laparostomy mandatory initially and abdominal wall approximation cannot be completed due to compromised state in most cases. Large incisional hernias were seen on complete healing and this study was done to see the feasibility of component separation technique (CST) with mesh augmentation.Methods: 30 patients were subjected to CST with mesh augmentation. Preoperative defect size mapping, Pre- and post-operative monitoring of IAP were done. Pain scoring by visual analogue scale (VAS), early and late complications was noted. Patients were followed up for 60 months.Results: CST with mesh augmentation was found to be feasible with 96.77% success rate as no recurrence was noted in follow up. Preoperative average Basal metabolic index was 26.09. Size of defect varied from 17-20×9-16 cm2 (length X width). Seroma seen in 50% of patients was managed without any intervention. Skin necrosis in 6.6% and wound dehiscence in 3.33%, managed with minimal debridement & local wound care respectively. Respiratory compromise and hematoma were not seen and no patient required any active ICU care. Average length of hospital stay was 5.22 days. Close monitoring of IAP in immediate post-operative period was found to be significant.Conclusion: Physical acceptance of stable abdominal wall gives a psychological boost to patients with early recovery in form of ambulation and early return to work.

Download Full-text

P010 FEASIBILITY OF MIDLINE RECONSTRUCTION WITHOUT MYOFASCIAL RELEASE (COMPONENT SEPARATION) AFTER PREOPERATIVE INFILTRATION OF LATERAL ABDOMINAL WALL MUSCULATURE WITH BOTULINUM TOXIN

British Journal of Surgery ◽

10.1093/bjs/znab395.009 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Ana Gabersek ◽

Franz Mayer ◽

Stefan Mitterwallner ◽

Reinhard Kaufmann ◽

Reinhard Bittner ◽

...

Keyword(s):

Botulinum Toxin ◽

Abdominal Wall ◽

Abdominal Wall Reconstruction ◽

Component Separation ◽

Ct Scans ◽

Width Ratio ◽

Surgical Trauma ◽

Lateral Abdominal Wall ◽

Myofascial Release ◽

Diaphragmatic Hernias

Abstract Aim Aim of the analysis was to evaluate whether preoperative botulinum toxin infiltration may facilitate anatomical midline reconstruction without the need for – otherwise pre-operative assumed – surgical component separation. Material and Methods Total of 58 patients with complex abdominal wall hernias were included in our single-center retrospective analysis between 03/2015 and 12/2020. Size of the defect, HSV/ACV-ratio, rectus-to-defect-width-ratio (“Carbonell-Index”) as well as risk factors were analyzed. In all patients muscles of the lateral abdominal wall were infiltrated with 300-500 IE of botulinum toxin 4 weeks prior to the abdominal wall reconstruction. CT scans were performed before and 4 weeks after the botulinum toxin infiltration. Results Total of 58 patients (M/F-ratio 36:22), with a mean age of 63.8 years were included in our analysis. Mean BMI was 29.5 kg/m². Total of 50 incisional, 3 umbilical, 2 posttraumatic diaphragmatic hernias and 3 scrotal hernias were analyzed. Surgical component separation after the infiltration with botulinum toxin was necessary in 43% of the cases. Conclusions Preoperative infiltration of the lateral abdominal wall musculature with botulinum toxin facilitated midline reconstruction of the abdominal wall without the need for myofascial release in 57%. Reduction of surgical trauma could therefore be achieved in several patients.

Download Full-text

Tensiometry as a Decision Tool for Abdominal Wall Reconstruction with Component Separation

World Journal of Surgery ◽

10.1007/s00268-009-9991-8 ◽

2009 ◽

Vol 33 (6) ◽

pp. 1174-1180 ◽

Cited By ~ 28

Author(s):

Adrian Dragu ◽

Peter Klein ◽

Frank Unglaub ◽

Elias Polykandriotis ◽

Ulrich Kneser ◽

...

Keyword(s):

Abdominal Wall ◽

Abdominal Wall Reconstruction ◽

Component Separation ◽

Decision Tool

Download Full-text

Component Separation of Abdominal Wall Muscles

Management of Abdominal Hernias ◽

10.1007/978-3-319-63251-3_26 ◽

2018 ◽

pp. 381-385 ◽

Cited By ~ 1

Author(s):

Flavio Malcher ◽

Leandro Totti Cavazzola

Keyword(s):

Abdominal Wall ◽

Component Separation

Download Full-text

Concomitant Anterior and Posterior Component Separations: Absolutely Contraindicated?

Surgical Innovation ◽

10.1177/1553350620914195 ◽

2020 ◽

pp. 155335062091419

Author(s):

Jorge Daes ◽

Joshua S. Winder ◽

Eric M. Pauli

Keyword(s):

Abdominal Wall ◽

Lateral Displacement ◽

Abdominal Wall Reconstruction ◽

Component Separation ◽

Transversus Abdominis ◽

Lateral Abdominal Wall ◽

Computed Tomography Images ◽

Fresh Cadaver ◽

Semilunar Line ◽

Internal Oblique

Many experts in abdominal wall reconstruction believe that the combination of simultaneous ipsilateral anterior component separation (ACS) and posterior component separation (PCS) is contraindicated. We performed ipsilateral endoscopic ACS and either endoscopic or open PCS-transversus abdominis release (TAR) in 5 fresh cadaver models. The full length of the semilunar line and the lateral abdominal wall remained well reinforced by 2 complete layers, comprising the internal oblique (IO) and TA muscles and their investing fasciae. Myofascial releases occurred 4 cm (median) apart. Additionally, we reviewed computed tomography images at 1 month and 1 year after PCS-TAR in 17 patients (30 PCS-TARs). Lateral displacement of the TA relative to the rectus abdominis (RA) was significant only at the superior mesenteric artery level, where it was <1 cm (median). Muscle mass changed minimally over time. Several studies showed that abdominal wall reconstruction after PCS-TAR results in compensatory muscular hypertrophy of the RA, external oblique (EO), and IO muscles and provides better quality of life and improved core physiology. These changes did not occur when the midline was not restored. Theoretically, endoscopic ACS-EO may be added to PCS-TAR to avoid partially bridged mesh repair in patients in whom complete midline restoration is impossible via PCS-TAR alone. Nevertheless, we advise most surgeons to perform a small-bridged repair instead of risking increased morbidity by attempting a highly complicated procedure.

Download Full-text