Reconstruction of the Abdominal Wall with Mesh I: Component Separation Techniques

2020 ◽  
Author(s):  
Samuel W. Ross ◽  
B. Todd Heniford ◽  
Vedra A. Augenstein
Keyword(s):  
Hernia Repair ◽  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Operative Management ◽  
Component Separation ◽  
Transversus Abdominis ◽  
Patient Specific ◽  
Wound Complications ◽  
Separation Techniques ◽  
Robotic Hernia Repair

Truly complex hernias which are multiply recurrent, have active infections, loss of domain, presence of stomas, require component separation or panniculectomy, and/or have other exacerbating factors, are truly challenging to manage operatively, and the multidisciplinary operations to repair them have become known collectively as abdominal wall reconstruction (AWR). Component separation techniques and panniculectomy, to name a few, have become commonly used techniques for operative management for complex hernias. Herein, we describe the history and technical aspects of component separation, panniculectomy and other adjunct techniques in abdominal wall reconstruction. In particular, a focus on patient specific clinical outcomes such as hernia recurrence, wound complications, and quality of life has been made in regards to use and types of component separation. Our goal is to provide a comprehensive review of the state of the literature and our recommendations for AWR, for the Plastic, General, and Hernia surgeon alike. This review contains 7 figures, 1 video, 1 table, and 79 references. Keywords: ventral hernia repair, incisional hernia, abdominal wall reconstruction. component separation, transversus abdominis release (TAR), surgical site infection, advances in hernia repair, robotic hernia repair, robotic component separation, botulinum toxin

Reconstruction of the Abdominal Wall with Mesh II: Ventral Hernia Repair

2020 ◽  
Author(s):  
Samuel W. Ross ◽  
B. Todd Heniford ◽  
Vedra A. Augenstein
Keyword(s):  
Hernia Repair ◽  
Abdominal Wall ◽  
Ventral Hernia ◽  
Clinical Outcomes ◽  
Ventral Hernia Repair ◽  
Abdominal Wall Reconstruction ◽  
Surgical Techniques ◽  
Patient Specific ◽  
Wound Complications ◽  
Robotic Hernia Repair

Incisional and Ventral hernia repair (VHR) is one of the most common surgical procedures in the world, and over the last two decades this field has enjoyed exponentially advances thanks to improvements in operative technique and biomechanical science. Truly complex hernias which are multiply recurrent, have active infections, loss of domain, presence of stomas, require component separation or panniculectomy, or have other exacerbating factors are truly challenging to manage operatively, and the multidisciplinary operations to repair them have become known collectively as abdominal wall reconstruction (AWR). Herein, we describe the surgical history of AWR, the current state of surgical techniques and mesh science, as well as novel areas for advancement of the field in the future. In particular, a focus on patient specific clinical outcomes such as hernia recurrence, wound complications, and quality of life has been made with regards to mesh position and selection. Our goal is to provide a comprehensive review of the state of the literature and our recommendations for AWR, for the Plastic, General, and Hernia surgeon alike. This review contains 7 figures, 3 tables, and 79 references. Keywords: ventral hernia repair, incisional hernia, abdominal wall reconstruction, mesh, pre-peritoneal hernia repair, pre-operative optimization, clinical outcomes, mesh position, surgical site infection, robotic hernia repair

scholarly journals Robotic hernia repair

Der Chirurg ◽  
2021 ◽  
Author(s):  
Ulrich A. Dietz ◽  
O. Yusef Kudsi ◽  
Miguel Garcia-Ureña ◽  
Johannes Baur ◽  
Michaela Ramser ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Component Separation ◽  
Transversus Abdominis ◽  
Nerve Sparing ◽  
Complication Rates ◽  
Robotic Hernia Repair ◽  
Lower Complication ◽  
Anterior Component Separation ◽  
Abdominal Reconstruction

AbstractThe principle of targeted separation or weakening of individual components of the abdominal wall to relieve tension in the median line during major abdominal reconstruction has been known for over 30 years as anterior component separation (aCS) and is an established procedure. In search of alternatives with lower complication rates, posterior component separation (pCS) was developed; transversus abdominis release (TAR) is a nerve-sparing modification of pCS. With the ergonomic resources of robotics (e.g., angled instruments), TAR can be performed in a minimally invasive manner (r-TAR): hernia gaps of up to 14 cm can be closed and a large extraperitoneal mesh implanted. In this video article, the treatment of large incisional hernias using the r‑TAR technique is presented. Exemplary results of a cohort study in 13 consecutive patients are presented. The procedure is challenging, but our own results—as well as reports from the literature—are encouraging. The r‑TAR is becoming the pinnacle procedure for abdominal wall reconstruction.

Concomitant Anterior and Posterior Component Separations: Absolutely Contraindicated?

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.

scholarly journals What Do We Know About Component Separation Techniques for Abdominal Wall Hernia Repair?

2018 ◽  
Vol 5 ◽  
Author(s):  
Hubert Scheuerlein ◽  
Andreas Thiessen ◽  
Christine Schug-Pass ◽  
Ferdinand Köckerling
Keyword(s):  
Hernia Repair ◽  
Abdominal Wall ◽  
Abdominal Wall Hernia ◽  
Component Separation ◽  
Separation Techniques ◽  
Abdominal Wall Hernia Repair

scholarly journals ABDOMINAL WALL RECONSTRUCTION BY BILATERAL TRANSVERSUS ABDOMINIS RELEASE – A MASTERLY PROCEDURE

2020 ◽  
pp. 10-11
Author(s):  
Anirban Bhunia ◽  
Soumyajyoti Panja
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Component Separation ◽  
Transversus Abdominis ◽  
Abdominal Hernia ◽  
Posterior Component Separation ◽  
Loss Of Domain ◽  
Ventral Incisional Hernia ◽  
Operative Recovery ◽  
Transversus Abdominis Muscle

BACKGROUND: In ventral hernia repair, closure of the defect is one of the most significant challenges, especially in a wide defect, large hernias with loss of domain, and recurrent hernias. Posterior component separation with transverses abdominis muscle release (TAR) is a novel approach that offers a solution for complex ventral hernias. AIMS AND OBJECTIVES: To assess the clinical effectiveness of posterior abdominal wall components separation with transversus abdominis muscle release (PCS-TAR) in the management of ventral abdominal hernia with loss of domain. METHOD: The posterior component separation by transversus abdominis muscle release (simply TAR) is a modification of the Rives-Stoppa procedure which combines it with developing of a large retro-muscular/pre-peritoneal plane and a consistent medial advancement of the abdominal wall musculature and accompanying fascia. This preserves the neurovascular bundles innervating the medial abdominal wall. Mesh is placed in a sublay fashion above the posterior layer. In an overwhelming majority of patients, the linea alba is reconstructed, creating a functional abdominal wall with wide mesh reinforcement. RESULT: We used this procedure in a case of large median ventral incisional hernia. Our patient was a known post-operative case of exploratory laparotomy for ileal perforation following blunt abdominal trauma. Ileostomy was done due to gross intraperitoneal contamination. His post-operative recovery was complicated by wound dehiscence previously. Patient presented with a hernia along the midline wound with a gap of 12*7 cm. After the abdominal wall reconstruction procedure (TAR) with mesh placement over posterior rectus sheath (15*20cm) his post op recovery was uneventful. There was no recurrence till follow up of 3 months. CONCLUSION: TAR seems to be the effective approach for complex hernias with good immediate outcomes.

scholarly journals Posterior Components Separation With Transversus Abdominis Release (TAR) Versus Alternative Techniques of Components Separation: Systematic Review

2018 ◽  
Vol 103 (7-8) ◽  
pp. 355-365
Author(s):  
Aseel Sleiwah ◽  
Sandra McAllister
Keyword(s):  
Abdominal Wall ◽  
Primary Repair ◽  
Abdominal Wall Reconstruction ◽  
Hernia Recurrence ◽  
Transversus Abdominis ◽  
Wound Complications ◽  
Cochrane Central Register ◽  
Components Separation ◽  
Abdominal Hernias ◽  
Wall Components

The aim of this study is to assess the clinical effectiveness of posterior abdominal wall components separation with transversus abdominis muscle release (PCS-TAR) in the management of ventral abdominal hernias. Ventral abdominal hernias complicate up to 11% of laparotomy wounds. Surgical management includes primary repair, hernioplasty, flaps, and components separation. A technique has been described to close large abdominal defects by releasing bilateral myofascial flaps of rectus abdominis from external oblique and advancing these flaps to the midline. Minimally invasive and endoscopic techniques were subsequently developed to reduce complications. A recently described method is PCS-TAR. The hypothesis is that PCS-TAR for abdominal wall reconstruction is associated with lower rates of wound complications and hernia recurrence than other components separation techniques. A comprehensive search of databases including Medline, Embase, Cochrane Central Register of Controlled Trials, and Scopus was conducted in accordance with PRISMA guidelines, looking for the primary outcomes of hernia recurrence and wound complications following different techniques of components separation. Inclusion and exclusion criteria were defined. The quality of studies was examined independently by 2 assessors. A total of 363 studies were identified. Three retrospective comparative studies met the inclusion criteria. No randomized control trial comparing different techniques of abdominal wall components separation was identified. No technique could be identified as superior to others, due to a paucity of the literature. However, based on a few retrospective cohort studies, PCS-TAR emerges as a well-tolerated new technique, with a low incidence of wound complications and hernia recurrence.

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