Successful closure of abdominal wall hernias using the components separation technique.

Abstract

The "components separation" technique involves separating the layers of the abdominal wall to allow midline advancement. The purpose of the study was to compare the success rate of the components repair versus other methods. Repair methods included components separation (n = 11), mesh (n = 15), primary (n = 21), TFL grafts (n = 5), TFL or latissimus flaps (n = 4), and rectus turnover (n = 4). The results were: 16 of 60 hernias recurred, with significant risk factors being body mass index (BMI) greater than 30 kg/m2 (p = 0.04), wound infection or breakdown (p < 0.03), and possibly concurrent colostomy or enterocutaneous fistula repair (p = 0.11). Only one of 11 hernias recurred using the components methods, four of 15 recurred using mesh repairs, three of 21 recurred using primary repairs, four of five recurred using TFL grafts, two of four recurred using TFL/latissimus flaps, and two of four recurred using rectus turnovers. There were 19 complications (infection or wound breakdown), with risk factors being smoking (p = 0.002) and possibly BMI greater than 30 kg/m2 (p = 0.08). The results suggest that the components separation method is a viable option for repair of complex abdominal wall hernias without the use of distant flaps or grafts.