Components-separation technique for closure of transverse non-midline abdominal wall incisional hernia

Espinosa-de-los-Monteros, Antonio; Franssen, Bernardo; Orozco, Vicente; Arriola, Juan Carlos; Romero, Héctor

doi:10.1016/j.bjps.2010.03.039

Cited by 13 publications

(5 citation statements)

References 14 publications

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“…On the other hand, large subcostal incisional hernias pose a peculiar challenge, since muscle mobilization is impaired in that anatomical site [2]. In the past, we have described the possibility of achieving muscle closure for large size subcostal incisional hernias using the ACS technique, and we used this method between 2007 and February 2015 [6]. Subsequently, we found that the muscle mobilization achieved by the TAR technique can also be applied in the subset of incisional subcostal hernias, and this has become our preferred method since February 2015 [7].…”

Section: Discussionmentioning

confidence: 99%

“…Written informed consent had been obtained from all participants to undergo their surgical procedure and for possible future research. The description of both surgical techniques for subcostal hernias has been published before by us [6,7], with the ACS technique being performed between April 2007 and February 2015, and the TAR technique being performed between February 2015 and October 2022. Briefly, in patients undergoing the ACS technique, the external oblique muscle on the same side as the hernia is separated from the internal oblique muscle laterally down to the level of the visible blood vessels to the external oblique muscle approximately at the level of the posterior axillary line.…”

Section: Methodsmentioning

confidence: 99%

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Comparison of open anterior component and open transversus abdominus release in repair of large subcostal hernias

Espinosa-de-los-Monteros,

Fernandez-Alva,

Solis-Reyna

et al. 2023

PLoS ONE

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Background Large subcostal incisional hernias are considered as complex defects, and a few different approaches have been described for repair. The purpose of this comparative cross-sectional study is to evaluate the outcomes of patients with large subcostal incisional hernias treated with either the open anterior components separation technique (ACS) or with the open transversus abdominis release technique (TAR). Methods From the database of patients with large complex incisional hernias who underwent abdominal wall reconstruction with open techniques between April 2007 and October 2022 at our institution, on May 25th, 2023 we identified those whose hernias were located in the subcostal areas and who underwent reconstruction with a components separation technique and mesh. Perioperative variables and outcomes were compared between the patients with large subcostal hernias who underwent abdominal wall reconstruction with either the ACS or the TAR techniques. Results Thirty-one patients with large subcostal hernias were included in the study. ACS and intra-abdominal mesh was used in 11 patients; TAR and retro-muscular mesh was performed in 20 patients. More postoperative local abdominal wall complications were seen in patients who had ACS as opposed to TAR (55% vs 15%, p = 0.02). Hernia recurrence was more common in patients who had ACS as opposed to TAR (55% vs 5%, p = 0.008). Conclusions More post-operative complications and recurrences were seen in patients who had ACS as opposed to TAR.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Comparison of open anterior component and open transversus abdominus release in repair of large subcostal hernias

Espinosa-de-los-Monteros,

Fernandez-Alva,

Solis-Reyna

et al. 2023

PLoS ONE

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“…In the past, we have described the possibility of achieving muscle closure for large size subcostal incisional hernias using the ACS technique, and we used this method between 2007 and February 2015 [6]. Subsequently, we found that the muscle mobilization achieved by the TAR technique can also be applied in the subset of incisional subcostal hernias, and this has become our preferred method since February 2015 [7].…”

Section: Discussionmentioning

confidence: 99%

“…During data collection, the authors had access to information that could identified individual participants, such as their full name. The description of both surgical techniques for subcostal hernias has been published before [6,7]. Briefly, in patients undergoing ACS technique, the external oblique muscle on the same side as the hernia is separated from the internal oblique muscle laterally down to the level of the visible blood vessels to the external oblique muscle approximately at the level of the posterior axillary line.…”

Section: Methodsmentioning

confidence: 99%

Comparison of Large Subcostal Hernias Treated With Open Anterior Components Separation or Open Transversus Abdominis Release Techniques

Espinosa-de-los-Monteros,

Fernandez-Alva,

Solis-Reyna

et al. 2023

Preprint

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Background: Large subcostal incisional hernias are considered as complex defects, and a few different approaches have been described for repair. The purpose of this comparative cross-sectional study is to evaluate the outcomes of patients with large subcostal incisional hernias treated with either the open anterior components separation technique (ACS) or with the open transversus abdominis release technique (TAR). Methods: From the database of patients with large complex incisional hernias who underwent abdominal wall reconstruction with open techniques between April 2007 and October 2022 at our institution, on May 25th, 2023 we identified those whose hernias were located in the subcostal areas and who underwent reconstruction with a components separation technique and mesh. Perioperative variables and outcomes were compared between the patients with large subcostal hernias who underwent abdominal wall reconstruction with either the ACS or the TAR techniques. Results: Thirty-one patients with large subcostal hernias were included in the study. ACS and intra-abdominal mesh was used in 11 patients; TAR and retro-muscular mesh was performed in 20 patients. More postoperative local abdominal wall complications were seen in patients undergoing ACS as opposed to TAR (55% vs 15%, p=0.02). Hernia recurrence was more common in patients undergoing ACS as opposed to TAR (55% vs 5%, p=0.008). Conclusions: More post-operative complications and recurrences were seen in patients undergoing ACS as opposed to TAR.

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“…2,5 Otherwise, component separation using autogenous tissues, or interpositional materials with a biological or synthetic mesh may be needed. 2,[10][11][12][13][14] These considerations have been better discussed elsewhere 2,[4][5][6][7][11][12][13][14] but are reiterated here to stress that such techniques are just as essential for a successful outcome in reconstruction of the abdominal wall as is the provision of adequate soft-tissue cover, which hereafter is the emphasis of the article. Any skin deficiency in a partial defect may be remedied by a simple skin graft, relaxing incisions, or tissue expansion, 7 but a complete defect, particularly with mesh exposure, may demand some form of vascularized tissue for coverage despite the projected gain with component separation alone, 15 using local, regional, or even a free flap if the defect is extreme.…”

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confidence: 99%

A Paradigm Shift for Soft-Tissue Coverage of the Zones of the Abdominal Wall Using Perforator Flaps

Hallock¹

2012

Plastic &Amp; Reconstructive Surgery

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Complete restoration of even basic function of the abdominal wall requires an intact and contractile musculofascial supporting system. Any incisions or flaps that denervate functioning muscle should be avoided. Perforator flaps have proven to be another reasonable option with which to restore any skin deficiencies whether as pedicled or free flaps and, because by definition no muscle is ever included, maximum function preservation of the abdominal wall will also thereby be achieved.

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Components-separation technique for closure of transverse non-midline abdominal wall incisional hernia

Cited by 13 publications

References 14 publications

Comparison of open anterior component and open transversus abdominus release in repair of large subcostal hernias

Comparison of open anterior component and open transversus abdominus release in repair of large subcostal hernias

Comparison of Large Subcostal Hernias Treated With Open Anterior Components Separation or Open Transversus Abdominis Release Techniques

A Paradigm Shift for Soft-Tissue Coverage of the Zones of the Abdominal Wall Using Perforator Flaps

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