WL Gore

Acell

Abstract:

There are over 350,000 ventral hernia repairs (VHR) performed in the United States annually and a variety of laparoscopic and open surgical techniques are described and utilized. Complex ventral hernias such as recurrent hernias, those with infected mesh, open wounds, coexisting enteric fistulas, parastomal hernias, and massive hernias—especially those with loss of abdominal domain—require sophisticated repair techniques. Many of these repairs are performed via an open approach. Ideally, the aim is to place mesh under the fascia with a large overlap of the defect and obtain primary fascial closure. However, it is often impossible to bring together fascial edges in very large hernias. Component separation is an excellent surgical technique in selected patients which involves release of the different layers of the abdominal wall and in turn helps accomplish primary fascial approximation. The posterior rectus sheath, external oblique or the transverse abdominis fascia can be cut and allows for closure of fascia in a tension free manner in a majority of patients. In this chapter we describe the various techniques for component separation, indications for use, how to select an appropriate type of release and post-operative outcomes.

Authors:

Samuel W. Ross, MD, MPH, Clinical Research Fellow, General Surgery Resident, Division of Gastrointestinal and Minimally Invasive Surgery , Department of Surgery , Carolinas Medical Center, Charlotte, NC, Bindhu Oommen, MD, MPH, Minimally Invasive Surgery Fellow, Division of Gastrointestinal and Minimally Invasive Surgery , Department of Surgery , Carolinas Medical Center, Charlotte, NC, B. Todd Heniford, MD, FACS, Professor of Surgery, Director, Carolinas Hernia Center, Chief, Division of Gastrointestinal and Minimally Invasive Surgery , Department of Surgery , Carolinas Medical Center, Charlotte, NC, Vedra A. Augenstein, MD, FACS , Assistant Professor of Surgery, Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC

PMID:  24700223

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