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Erschienen in: Hernia 2/2020

Open Access 05.03.2020 | Original Article

Combining anterior and posterior component separation for extreme cases of abdominal wall reconstruction

verfasst von: J. Lopez-Monclus, J. Muñoz-Rodríguez, C. San Miguel, A. Robin, L. A. Blazquez, M. Pérez-Flecha, N. Rupealta, M. A. Garcia-Urena

Erschienen in: Hernia | Ausgabe 2/2020

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Abstract

Purpose

The closure of midline in abdominal wall incisional hernias is an essential principle. In some exceptional circumstances, despite adequate component separation techniques, this midline closure cannot be achieved. This study aims to review the results of using both anterior and component separation in these exceptional cases.

Methods

We reviewed our experience using the combination of both anterior and posterior component separation in the attempt to close the midline. Our first step was to perform a TAR and a complete extensive dissection of the retromuscular preperitoneal plane developed laterally as far as the posterior axillary line. When the closure of midline was not possible, an external oblique release was made. A retromuscular preperitoneal reinforcement was made with the combination of an absorbable mesh and a 50 × 50 polypropylene mesh.

Results

Twelve patients underwent anterior and posterior component separation. The mean hernia width was 23.5 ± 5. The majority were classified as severe complex incisional hernia and had previous attempts of repair. After a mean follow-up of 27 months (range 8–45), no case of recurrence was registered. Only one patient (8.33%) presented with an asymptomatic bulging in the follow-up. European Hernia Society’s quality of life scores showed a significant improvement at 2 years postoperatively in the three domains: pain (p = 0.01), restrictions (p = 0.04) and cosmetic (p = 0.01).

Conclusions

The combination of posterior and anterior component separation can effectively treat massive and challenging cases of abdominal wall reconstruction in which the primary midline closure is impossible to achieve despite appropriate optimization of surgery.
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Metadaten
Titel
Combining anterior and posterior component separation for extreme cases of abdominal wall reconstruction
verfasst von
J. Lopez-Monclus
J. Muñoz-Rodríguez
C. San Miguel
A. Robin
L. A. Blazquez
M. Pérez-Flecha
N. Rupealta
M. A. Garcia-Urena
Publikationsdatum
05.03.2020
Verlag
Springer Paris
Erschienen in
Hernia / Ausgabe 2/2020
Print ISSN: 1265-4906
Elektronische ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-020-02152-3

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