Down to Up Posterior Component Separation Technique

Abstract

The size of the hernia defect is the main factor in choosing between the different abdominal wall repair techniques. Small or medium-sized defects (up to 7–8 cm) could be approached using minimally invasive techniques (laparoscopic or endoscopic approaches, Mini or Less Open Sublay Operation (MILOS)) or by performing an open Rives-Stoppa technique. The vast majority of defects can be repaired with a Rives-Stoppa technique. For larger defects (>10 cm) our first option is to perform a posterior component separation technique (PCS). In 2012, Novitsky described the PCS using transversus abdominis muscle release (TAR); since then, TAR-PCS-TAR has been widely used by the abdominal wall surgical community worldwide in the treatment of complex abdominal wall defects and obtaining excellent long-term results. TAR-PCS-TAR is also an excellent technique for the treatment of complex lateral abdominal wall defects, L1–L4 of the European Hernia Society (EHS) classification, especially those close to bone structures. Furthermore, TAR-PCS-TAR is an ideal technique in the presence of simultaneous midline and lateral incisional hernias and also for the treatment of complex parastomal defects. Nowadays, our choice for treating complex abdominal wall defects is to perform a modification of the Novitsky’s TAR, known in the literature as Madrid PCS-TAR modification.