Abstract
Repair of midline incisional hernias is a common procedure for which two related problems need to be solved. First, how can this high-tension internal closure best be achieved without the sutures cheesewiring through the fascia over time? Meshes are commonly used to distribute tension, but the optimal location of the mesh, its size, and the method of fixation are hotly debated. Equally argued is the optimal handling of the soft tissues required to place the mesh. This chapter will describe a means to reliably close a midline abdominal wall defect using a well-fixed narrow retrorectus mesh and a perforator-sparing anterior components release.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Raines JK, Jaffrin MY, Rao S. A non-invasive pressure-pulse recorder: development and rationale. Med Instrum. 1973;7:245.
Gibbons GW, Wheelock FC, Hoar CC, et al. Predicting success of forefoot amputations in diabetics by noninvasive testing. Arch Surg. 1979;114:1034.
Chang N, Mathes SJ. Comparison of the effect of bacterial inoculation on musculocutaneous and random pattern flaps. Plast Reconstr Surg. 1982;70:1.
Feng LF, Price D, Hohn D, Mathes SJ. Blood flow changes and leukocyte mobilization in infection: a comparison between ischemia and well-perfused skin. Surg Forum. 1983;34:603.
Abbott DE, Halverson AL, Wayne JD, Kim JY, Talamonti MS, Dumanian GA. The oblique rectus abdominis myocutaneous flap for complex pelvic wound reconstruction. Dis Colon Rectum. 2008;51:1237–41.
Dumanian GA. Discussion: minimally invasive component separation with inlay bioprosthetic mesh (MICSIB) for complex abdominal wall reconstruction. Plast Reconstr Surg. 2011;128:710–2.
Lowe JB, Garza JR, Bowman JL, Rohrich RJ, Strodel WE. Endoscopically assisted “components separation” for closure of abdominal wall defects. Plast Reconstr Surg. 2000;105:720–9.
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;189:138–40.
Saulis A, Dumanian GA. Periumbilical rectus abdominis perforator preservation significantly reduces superficial wound complications in “Separation of Parts” hernia repairs. Plast Reconstr Surg. 2002;109:2275.
Ghali S, Turza K, Baumann DP, Butler CE. Minimally invasive component separation results in fewer wound-healing complications than open component separation for large ventral hernia repairs. J Am Coll Surg. 2012;214:981–9.
Armananzas L, Ruiz-Tovar J, Arroyo A, et al. Prophylactic mesh vs suture in the closure of the umbilical trocar site after laparoscopic cholecystectomy in high-risk patients for incisional hernia: a randomized clinical trial. J Am Coll Surg. 2014;218:960–8.
Alexander CH, Prudden JF. The causes of abdominal wound disruption. SGO. 1966;122:1223–9.
Rodeheaver GT, Nesbit WS, Edlich RF. Novafil, a dynamic suture for wound closure. Ann Surg. 1986;204:193–9.
Israelsson LA, Millbourn D. Closing midline abdominal incisions. Langenbecks Arch Surg. 2012;397:1201–7.
Playforth MJ, Sauven PD, Evans M, Pollock AV. The prediction of incisional hernias by radio-opaque markers. Ann Royal Col Surg Eng. 1986;68:82–4.
Pollock AV, Evans M. Early prediction of late incisional hernias. Br J Surg. 1989;76:953–4.
Burger JW, Lange JF, Halm JA, Kleinrensink G-J, Jeekel H. Incisional hernia: early complication of abdominal surgery. World J Surg. 2005;29:1608–13.
Xing L, Culbertson EJ, Wen Y, Franz MG. Early laparotomy wound failure as the mechanism for incisional hernia formation. J Surg Res. 2013;182:e35–42.
Ellis H, Gajraj H, George CD. Incisional hernias: when do they occur? Br J Surg. 1983;70:290–1.
Hoes J, Fischer L, Schachtrupp A. Laparotomy closure and incisional hernia prevention—what are the surgical requirements. Zentralbl Chir. 2011;136:42–9.
Klink CD, Binnebosel M, Alizai PH, Lambertz A, von Trotha KT, Junker E, et al. Tension of knotted surgical sutures shows tissue specific rapid loss in a rodent model. BMC Surg. 2011;11:36–45.
Cheesborough JE, Dumanian GA. Simultaneous prosthetic mesh abdominal wall reconstruction with abdominoplasty for ventral hernia and severe rectus diastasis repairs. Plast Reconstr Surg. 2015;135:268–76.
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;228:3046–52.
Luijendijk RW, Hop WC, van den Tol MP, et al. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med. 2000;343:392–8.
Slater NJ, van Goor H, Bleichrodt RP. Large and complex ventral hernia repair using “components separation technique” without mesh results in a high recurrence rate. Am J Surg. 2015;209:170–9.
Souza JM, Dumanian GA. Routine use of bioprosthetic mesh is not necessary: a retrospective review of 100 consecutive cases of intraabdominal midweight polypropylene mesh for ventral hernia repair. Surgery. 2013;153:393–9.
Iqbal CW, Pham TH, Joseph A, Mai J, Thompson GB, Sarr MG. Long-term outcome of 254 complex incisional hernia repairs using the modified Rives-Stoppa technique. World J Surg. 2007;31:2398–404.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Electronic Supplementary Material
Perforator Preserving Open ACS, by Dumanian (MP4 368,919 kb)
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Dumanian, G.A. (2016). Open Anterior Component Separation with Perforator Preservation. In: Novitsky, Y. (eds) Hernia Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-27470-6_16
Download citation
DOI: https://doi.org/10.1007/978-3-319-27470-6_16
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-27468-3
Online ISBN: 978-3-319-27470-6
eBook Packages: MedicineMedicine (R0)