Hernia Surgery pp 149-158 | Cite as

Endoscopic Anterior Component Separation

  • David EarleEmail author


Endoscopic component separation (ECS) generally refers to a perforator sparing technique to access the oblique muscle complex for the purposes of separating the internal and external oblique muscles, and dividing the insertion of the external oblique medially. While most surgeons perform this for the sole purpose of intra-operative mobilization, we also believe that there is a significant role of reducing postoperative tension during bilateral activation of the oblique muscles with activities such as coughing. We believe that this will allow the midline closure to heal better, compared to having the full force of the oblique muscle complex pulling in opposite directions. The technique is used in conjunction with an open hernia repair utilizing a sublay prosthetic that is individualized to the specific patient. ECS has been shown to be associated with slightly improved wound morbidity as compared to the traditional open component separation (OCS). ECS certainly appears to be a viable alternative to OCS with fewer superficial wound complications; however, one must be mindful of the reported trends toward increased recurrence rate.


Endoscopic component separation Abdominal wall reconstruction Incisional hernia External oblique Internal oblique Sublay hernia repair 

Supplementary material

Video 15.1

Endoscopic Anterior Component Separation, by Roth (MP4 152,643 kb)

Audio 15.2

Laparoscopic AWR, by Daes (MP4 148,774 kb)


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Tufts University School of MedicineSpringfieldUSA

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