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Changes in the abdominal wall after anterior, posterior, and combined component separation

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Abstract

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Knowledge of the changes that occur in the abdominal wall after component separation (CS) is essential for understanding the mechanisms of action of the various CS techniques, the changes observed on computed tomography images, and, perhaps most importantly, the anatomic and physiologic changes observed in patients who have undergone CS.

Abstract

Purpose Component separation (CS) techniques are essential adjuncts during most abdominal wall reconstructions. They allow the fulfillment of most modern abdominal wall reconstruction principles, especially primary closure of defects and linea alba restoration under physiologic tension. Knowledge of the post-CS abdominal wall changes is essential to understanding the mechanism of action of the various types of CS, the changes observed on computed tomographic images, and, perhaps most importantly, the anatomic and physiologic changes following CS techniques.

Methods A systematic review of the literature was conducted using the PubMed database and other sources to identify articles describing abdominal wall changes after CS

Results After excluding non-pertinent articles, 14 articles constituted the basis for this review. 

Conclusions After reviewing the literature on post CS abdominal wall changes, we conclude the following: (1)The external oblique muscle is significantly displaced laterally after anterior CS, the transversus abdominis muscle shifts very little after posterior CS, and muscle trophism is generally maintained after both techniques. These findings are consistent for both open and minimally invasive CS. (2) The anatomy and physiology of abdominal wall muscles are preserved mainly by the muscles’ overlapping function and their ability to undergo compensatory trophism after midline restoration (reloading). (3) Well-performed CS techniques have a low risk of producing bulging and semilunar line hernias. (4) Anterior and posterior CS techniques probably have different mechanisms of action. (5) Current studies on how the nutritional status and postoperative conditioning can alter abdominal wall changes after CS and the mechanisms of the actions involved in anterior and posterior CS are underway.

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References

  1. Daes J, Telem D (2019) The principled approach to ventral hernia repair. Rev Colomb Cir 34:25–28. https://doi.org/10.30944/20117582.94

    Article  Google Scholar 

  2. Jensen KK, Munim K, Kjaer M, Jorgensen LN (2017) Abdominal wall reconstruction for incisional hernia optimizes truncal function and quality of life: a prospective controlled study. Ann Surg 265:1235–1240

    Article  Google Scholar 

  3. Novitsky YW, Fayezizadeh M, Majumder A, Neupane R, Elliott HL, Orenstein SB (2016) Outcomes of posterior component separation with transversus abdominis muscle release and synthetic mesh sublay reinforcement. Ann Surg 264:226–232

    Article  Google Scholar 

  4. Winder JS, Behar BJ, Juza RM, Potochny J, Pauli EM (2016) Transversus abdominis release for abdominal wall reconstruction: early experience with a novel technique. J Am Coll Surg 223:271–278

    Article  Google Scholar 

  5. Ferretis M, Orchard P (2015) Minimally invasive component separation techniques in complex ventral abdominal hernia repair: a systematic review of the literature. Surg Laparosc Endosc Percutan Tech 25:100–105

    Article  Google Scholar 

  6. Daes J (2014) Endoscopic subcutaneous approach to component separation. J Am Coll Surg 218:e1–e4

    Article  Google Scholar 

  7. Daes J, Chen DC (2017) Endoscopic components separation techniques. In: Hope WW, Cobb WS, Adrales GL (eds) Textbook of hernia. Springer, Basel, pp 243–248

    Chapter  Google Scholar 

  8. Daes J, Dennis RJ (2017) Endoscopic subcutaneous separation as an adjunct to abdominal wall reconstruction. Surg Endosc 31:872–876

    Article  Google Scholar 

  9. Jensen KK, Henriksen NA, Jorgensen LN (2014) Endoscopic component separation for ventral hernia causes fewer wound complications compared to open components separation: a systematic review and meta-analysis. Surg Endosc 28:3046–3052

    Article  Google Scholar 

  10. DuBay DA, Choi W, Urbanchek MG, Wang X, Adamson B, Dennis RG, Kuzon WM Jr, Franz MG (2007) Incisional herniation induces decreased abdominal wall compliance via oblique muscle atrophy and fibrosis. Ann Surg 245:140–146

    Article  Google Scholar 

  11. Culbertson EJ, Xing L, Wen Y, Franz MG (2013) Reversibility of abdominal wall atrophy and fibrosis after primary or mesh herniorrhaphy. Ann Surg 257:142–149

    Article  Google Scholar 

  12. Den Hartog D, Eker HH, Tuinebreijer WE, Kleinrensink GJ, Stam HJ, Lange JF (2010) Isokinetic strength of the trunk flexor muscles after surgical repair for incisional hernia. Hernia 14:243–247

    Article  Google Scholar 

  13. Alkhatib H, Tastaldi L, Krpata DM, Petro CC, Fafaj A, Rosenblatt S et al (2020) Outcomes of transversus abdominis release (TAR) with permanent synthetic retromuscular reinforcement for bridged repairs in massive ventral hernias: a retrospective review. Hernia 24:341–352

    Article  CAS  Google Scholar 

  14. Jin J, Rosen MJ, Blatnik J, McGee MF, Williams CP, Marks J et al (2007) Use of acellular dermal matrix for complicated ventral hernia repair: does technique affect outcomes? J Am Coll Surg 205:654–660

    Article  Google Scholar 

  15. Blatnik J, Jin J, Rosen M (2008) Abdominal hernia repair with bridging acellular dermal matrix—an expensive hernia sac. Am J Surg 196:47–50

    Article  Google Scholar 

  16. De Silva GS, Krpata DM, Hicks CW, Criss CN, Gao Y, Rosen MJ et al (2014) Comparative radiographic analysis of changes in the abdominal wall musculature morphology after open posterior component separation or bridging laparoscopic ventral hernia repair. J Am Coll Surg 218:353–357

    Article  Google Scholar 

  17. Daes J, Winder JS, Pauli EM (2020) Concomitant anterior and posterior component separations: absolutely contraindicated? Surg Innov 27:328–332

    Article  Google Scholar 

  18. Oma E, Christensen JK, Daes J, Jorgensen LN (2021) Alterations in the abdominal wall musculature after endoscopic anterior and open posterior component separation. [Abstract accepted for presentation at the Joint Meeting of the American and European Hernia Societies, Copenhagen, October 2021].

  19. Criss CN, Petro CC, Krpata DM, Seafler CM, Lai N, Fiutem J et al (2014) Functional abdominal wall reconstruction improves core physiology and quality-of-life. Surgery 156:176–182

    Article  Google Scholar 

  20. Hicks CW, Krpata DM, Blatnik JA, Novitsky YW, Rosen MJ (2012) Long-term effect on donor sites after components separation: a radiographic analysis. Plast Reconstr Surg 130:354–359

    Article  CAS  Google Scholar 

  21. Daes J, Morrell D, Pauli EM (2021) Changes in the lateral abdominal wall following endoscopic subcutaneous anterior component separation. Hernia 25:85–90

    Article  CAS  Google Scholar 

  22. Cavalli M, Bruni PG, Lombardo F, Morlacchi A, Andretto Amodeo C, Campanelli G (2020) Original concepts in anatomy, abdominal-wall surgery, and component separation technique and strategy. Hernia 24:411–419

    Article  CAS  Google Scholar 

  23. Lisiecki J, Kozlow JH, Agarwal S, Ranganathan K, Terjimanian MN, Rinkinen J, Brownley RC, Enchakalody B, Wang SC, Levi B (2015) Abdominal wall dynamics after component separation hernia repair. J Surg Res 193:497–503

    Article  Google Scholar 

  24. Pauli EM, Wang J, Petro CC, Juza RM, Novitsky YW, Rosen MJ (2015) Posterior component separation with transversus abdominis release successfully addresses recurrent ventral hernias following anterior component separation. Hernia 19:285–291

    Article  CAS  Google Scholar 

  25. Lopez-Monclus J, Muñoz-Rodríguez J, San Miguel C, Robin A, Blazquez LA, Pérez-Flecha M et al (2020) Combining anterior and posterior component separation for extreme cases of abdominal wall reconstruction. Hernia 24:369–379

    Article  CAS  Google Scholar 

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Acknowledgements

We thank Nancy Schatken, BS, MT(ASCP) and Angela Morben, DVM, ELS, from Edanz (https://www.edanz.com/ac), for editing a draft of this manuscript.

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Authors and Affiliations

  1. Minimally Invasive Surgery Department, Clínica Porto Azul, Carrera 58, Número 79-223 PH B, Barranquilla, Colombia

    J. Daes

  2. Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, 2400, Copenhagen, NV, Denmark

    E. Oma & L. N. Jorgensen

Authors
  1. J. Daes
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  2. E. Oma
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  3. L. N. Jorgensen
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Contributions

Study concept and design JD, Acquisition of data JD, EO, LNJ, Analysis and interpretation JD, EO, LNJ, Study supervision LNJ, JD.

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Correspondence to J. Daes.

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the author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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IRB approval was waived due to the nature of the study.

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The research did not involve human participants. Animals did not participate in the study. Only non-identifiable material was used in the present study.

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Informed consent was waived due to the nature of the study.

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Daes, J., Oma, E. & Jorgensen, L.N. Changes in the abdominal wall after anterior, posterior, and combined component separation. Hernia 26, 17–27 (2022). https://doi.org/10.1007/s10029-021-02535-0

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  • DOI: https://doi.org/10.1007/s10029-021-02535-0

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