Surgical Endoscopy

, Volume 32, Issue 5, pp 2474–2479 | Cite as

Single port component separation: endoscopic external oblique release for complex ventral hernia repair

  • Kristen E. Elstner
  • John W. Read
  • Anita S. W. Jacombs
  • Rodrigo Tomazini Martins
  • Fernando Arduini
  • Peter H. Cosman
  • Omar Rodriguez-Acevedo
  • Anthony N. Dardano
  • Alex Karatassas
  • Nabeel Ibrahim
Article

Abstract

Background

Component separation (CS) is a technique which mobilizes flaps of innervated, vascularized tissue, enabling closure of large ventral hernia defects using autologous tissue. Disadvantages include extensive tissue dissection when creating these myofascial advancement flaps, with potential consequences of significant post-operative skin and wound complications. This study examines the benefit of a novel, ultra-minimally invasive single port anterior CS technique.

Methods

This was a prospective study of 16 external oblique (EO) releases performed in 9 patients and 4 releases performed in 3 fresh frozen cadavers. All patients presented with recurrent complex ventral hernias, and were administered preoperative Botulinum Toxin A to their lateral oblique muscles to facilitate defect closure. At the time of elective laparoscopic repair, patients underwent single port endoscopic EO release using a single 20-mm incision on each side of the abdomen. Measurements were taken using real-time ultrasound. Postoperatively, patients underwent serial examination and abdominal CT assessment.

Results

Single port endoscopic EO release achieved a maximum of 50-mm myofascial advancement per side (measured at the umbilicus). No complications involving wound infection, hematoma, or laxity/bulge have been noted. All patients proceeded to laparoscopic or laparoscopic-open-laparoscopic intraperitoneal mesh repair of their hernia, with no hernia recurrences to date.

Conclusions

Single port endoscopic EO release holds potential as an adjunct in the repair of large ventral hernia defects. It is easy to perform, is safe and efficient, and entails minimal disruption of tissue planes and preserves abdominal wall perforating vessels. It requires only one port-sized incision on each side of the abdomen, thus minimizing potential for complications. Further detailed quantification of advancement gains and morbidity from this technique is warranted, both with and without prior administration of Botulinum Toxin A to facilitate closure.

Keywords

Component separation Ventral hernia Endoscopic External oblique release Minimally invasive 

Notes

Compliance with ethical standards

Disclosures

John Read declares conflict of interest related to the submitted work as he receives financial remuneration from Medicare as a radiologist. Kristen Elstner, Omar Rodriguez-Acevedo, Peter Cosman, Anita Jacombs, Alex Karatassas, Rodrigo Martins, Fernando Arduini, Nabeel Ibrahim, and Anthony Dardano have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Ramirez OM, Ruas E, Dellon AL (1990) “Components Separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 86:519–526CrossRefPubMedGoogle Scholar
  2. 2.
    Deerenberg EB, Timmermans L, Hogerzeil DP, Slieker JC, Eilers PHC, Jeekel J, Lange JF (2015) A systematic review of the surgical treatment of large incisional hernia. Hernia 19:89–101CrossRefPubMedGoogle Scholar
  3. 3.
    Heller L, McNichols CH, Ramirez OM (2012) Component separations. Semin Plast Surg 26:25–28CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Heller L, Chike-Obi C, Xue AS (2012) Abdominal wall reconstruction with mesh and components separation. Semin Plast Surg 26:29–35CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Saulis AS, Dumanian GA (2002) Periumbilical rectus abdominis perforator preservation significantly reduces superficial wound complications in “separation of parts” hernia repairs. Plast Reconstr Surg 109:2275–2282CrossRefPubMedGoogle Scholar
  6. 6.
    Lowe JB, Garza JR, Bowman JL, Rohrich RJ, Strodel WE (2000) Endoscopically assisted “components separation” for closure of abdominal wall defects. Plast Reconstr Surg 105:720–729CrossRefPubMedGoogle Scholar
  7. 7.
    Maas SM, de Vries Reilingh TS, van Goor H, de Jong D, Bleichrodt RP (2002) Endoscopically assisted “components separation technique” for the repair of complicated ventral hernias. J Am Coll Surg 194:388–390CrossRefPubMedGoogle Scholar
  8. 8.
    Rosen MJ, Williams C, Kin J, McGee MF, Schomisch S, Marks J, Ponsky J (2007) Laparoscopic versus open-component separation: a comparative analysis in a porcine model. Am J Surg 194:385–389CrossRefPubMedGoogle Scholar
  9. 9.
    Elstner KE, Jacombs ASW, Read JW, Rodriguez O, Edye M, Cosman PH, Dardano AN, Zea A, Boesel T, Mikami DJ, Craft C, Ibrahim N (2016) Laparoscopic repair of complex ventral hernia facilitated by pre-operative chemical component relaxation using Botulinum Toxin A. Hernia 20:209–219CrossRefPubMedGoogle Scholar
  10. 10.
    Elstner KE, Read JW, Rodriguez-Acevedo O, Cosman PH, Dardano AN, Jacombs ASW, Edye M, Zea A, Boesel T, Mikami DJ, Ibrahim N (2017) Preoperative chemical component relaxation using Botulinum Toxin A: enabling laparoscopic repair of complex ventral hernia. Surg Endosc 31:761–768CrossRefPubMedGoogle Scholar
  11. 11.
    Daes J (2014) Endoscopic subcutaneous approach to component separation. J Am Coll Surg 218:e1–e4CrossRefPubMedGoogle Scholar
  12. 12.
    Ghali S, Turza KC, Baumann DP, Butler CE (2012) Minimally invasive component separation results in fewer wound-healing complications than open component separation for large ventral hernia repairs. J Am Coll Surg 214:981–989CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Kristen E. Elstner
    • 1
    • 2
  • John W. Read
    • 3
  • Anita S. W. Jacombs
    • 1
    • 2
  • Rodrigo Tomazini Martins
    • 2
  • Fernando Arduini
    • 2
  • Peter H. Cosman
    • 1
    • 2
  • Omar Rodriguez-Acevedo
    • 2
  • Anthony N. Dardano
    • 4
  • Alex Karatassas
    • 5
  • Nabeel Ibrahim
    • 1
    • 2
    • 6
  1. 1.Macquarie University HospitalMacquarieAustralia
  2. 2.Hernia Institute AustraliaEdgecliffAustralia
  3. 3.Macquarie Medical ImagingMacquarie University HospitalMacquarieAustralia
  4. 4.Boca Raton Regional HospitalBoca RatonUSA
  5. 5.Discipline of SurgeryUniversity of AdelaideAdelaideAustralia
  6. 6.EdgecliffAustralia

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