Endoscopic Anterior Component Separation

Abstract

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.