Posterior and open anterior components separations: a comparative analysis

• Published in: The American journal of surgery Vol. 203; no. 3; pp. 318 - 322
• Main Authors: Krpata, David M., M.D, Blatnik, Jeffrey A., M.D, Novitsky, Yuri W., M.D, Rosen, Michael J., M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2012; Elsevier; Elsevier Limited
• Subjects: Abdomen; Abdominal wall; Abdominal Wall - surgery; Abdominal wall reconstruction; Abdominal Wound Closure Techniques; Aged; Biological and medical sciences; Chronic obstructive pulmonary disease; Comparative analysis; Complications; Components separation; Defects; Endoscopy; Fascia; Female; General aspects; Hernia, Abdominal - surgery; Hernias; Herniorrhaphy - instrumentation; Herniorrhaphy - methods; Humans; Logistic Models; Male; Medical personnel; Medical sciences; Middle Aged; Morbidity; Muscles; Patients; Postoperative Complications; Recurrence; Retrospective Studies; Separation; Skin; Surgeons; Surgery; Surgical Flaps; Surgical Mesh; Treatment Outcome; Variables; Ventral hernia; Wound healing; Abdominal wall reconstruction; Components separation; Ventral hernia; Separation; Anterior; Anatomical reconstruction; Hernia; Medicine; Components; Treatment; Surgery; Posterior; Abdominal wall; reconstruction; Comparative study
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2011.10.009

Abstract Background Anterior components separation (ACS) creates large lipocutaneous flaps to release the external oblique fascia often leading to major wound complications. Posterior components separation (PCS) involves the release of the posterior rectus sheath and transversus abdominis muscles. We hypothesized that PCS provides effective fascial advancement while reducing wound morbidity during abdominal wall reconstructions. Methods A retrospective review of consecutive components separation performed by a single surgeon over 5 years. Results One hundred eleven patients (56 ACS/55 PCS) were analyzed. The mean defect size was 472 and 531 cm2 , respectively ( P = .28). Five patients in each group required a bridging repair. Wound complications occurred in significantly more ACS than PCS patients (48.2% vs 25.5%, P = .01). The recurrence rate was also higher in the ACS group (14.3% vs 3.6%, P = .09). Conclusions PCS provides equivalent myofascial advancement with significantly less wound morbidity when compared with ACS. Although further studies are needed, PCS has evolved as an important addition to the armamentarium of surgeons undertaking complex abdominal wall reconstructions.