Decreasing the Reherniation Rate Using a Modified Components Separation Technique

Excerpt

We commend Dr. de Vries Reilingh and the other authors for conducting a prospective randomized trial on the repair of giant midline abdominal wall hernias. Their results showed that the components separation technique (CST) provides excellent abdominal wall closure while avoiding the complications often associated with the use of a prosthetic material. We were, however, concerned with the reported reherniation rate. In their series, 10 of 19 patients experienced reherniation after a mean period of 7 months [1]. We would suggest that this high rate of reherniation was secondary to their technique. Although the CST procedure described by Ramirez does offer substantial mobility of the abdominal wall, a further modification that we use frequently is division of the internal oblique component of the anterior rectus sheath superior to the costal margins inferior to the arcuate line [2, 3]. We have found that this method provides more mobilization of the upper abdominal wall. If this technique had been used, possibly the 53% reherniation rate reported by de Vries Reilingh et al., all of which occurred in the midline of the upper abdomen, may have been lower. In a retrospective review of 73 of our abdominal reconstructions for giant abdominal wall hernias (avg. 30 × 20 cm) using the modified CST (MCST), our reherniation rate was only 5% after a mean follow-up of 24 months [3]. The Netherlands’ study further mentions that the posterior rectus sheath was separated only if “tension-free closure was impossible.” We wonder how many of the reconstructions performed did not use this division and were truly completely tension-free. …