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Original concepts in anatomy, abdominal-wall surgery, and component separation technique and strategy

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Abstract

Background

The abdominal wall can be considered comprised of two compartments: an anterior and a posterior compartment. The anterior compartment includes the anterior rectus sheath and the rectus muscle. The posterior compartment comprises the posterior rectus sheath, the transversalis fascia, and the peritoneum. When a large defect in the anterior compartment has to be corrected, for example, a rectus diastasis or large incisional hernia, an action on the anterior compartment is necessary; therefore, an anterior component separation has to be considered. If a loss of substance is present in the posterior compartment, a trasversus abdominis release should be accomplished.

Methods

We propose an original anterior compartment mobilisation, by a posterior approach. Dissection of the posterior rectus sheet proceeds until the linea semilunaris is reached. Incision of the anterior rectus sheath permits a mobilisation of the anterior compartment by a posterior approach. A mesh is placed in a sublay position. If the abdominal wall presents a loss of substance of the posterior compartment, a transversus abdominis release (TAR) can be performed in the same time.

Results

No hernia recurrences, no wound infection, and no mesh infection have been reported.

Conclusions

The anterior compartment mobilization permits mobilization towards the midline of rectus muscle and restoration of anterior compartment, with low morbidity rate; it can be easily associated to a large sublay mesh placement, it allows the preservation of the neurovascular bundles and rectus muscle trophism, and it can be associated with a concomitant TAR procedure for the restoration of the PC, if necessary.

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Authors and Affiliations

  1. Center of Research On the Pathology and High Specialization On the Abdominal Wall and Hernia Surgery, Milano Hernia Center, Istituto Clinico Sant’Ambrogio, University of Insubria, Via Faravelli 16, 20147, Milan, Italy

    M. Cavalli, P. G. Bruni, F. Lombardo, A. Morlacchi & G. Campanelli

  2. Ecole De Chirurgie Du Fer à Moulin, Paris, Italy

    C. Andretto Amodeo

Authors
  1. M. Cavalli
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  2. P. G. Bruni
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  3. F. Lombardo
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  4. A. Morlacchi
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  5. C. Andretto Amodeo
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  6. G. Campanelli
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Corresponding author

Correspondence to M. Cavalli.

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All authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Cavalli, M., Bruni, P.G., Lombardo, F. et al. Original concepts in anatomy, abdominal-wall surgery, and component separation technique and strategy. Hernia 24, 411–419 (2020). https://doi.org/10.1007/s10029-019-02030-7

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  • DOI: https://doi.org/10.1007/s10029-019-02030-7

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