IMPACT OF COMBINED COMPONENT SEPARATION TECHNIQUE muadgamil@yahoo.com

 

IMPACT OF COMBINED COMPONENT SEPARATION TECHNIQUE

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Yemen

Oral only

Closure of large anterior abdominal wall defects is challenging, with no standard management approach. This study presents our experience using a new modified reconstructive technique for effective repair.

This retrospective study was conducted at Al Naqib Hospital in Aden/Yemen, between 2012 and 2020. Twenty-six patients (14 men, 12 women) with large midline abdominal wall defects of various etiologies underwent surgical repair. All patients underwent a combination of shoelace repair and the component separation technique. The procedure involved bilateral longitudinal division of the anterior rectus sheet and creation of a posterior layer of new Linea alba by approximation of the medial edges of the divided rectus sheet (shoelace abdominoplasty) and anterior external oblique muscle aponeurosis separation (Ramirez component separation technique). This ensured more space to avoid the tense approximation of the lateral edges of the divided rectus sheet and move the rectus muscles toward the midline for constructing the anterior abdominal layer. The posterior and anterior layers and bilateral separated sheets were covered with a polypropylene mesh in all patients, except in those who underwent emergency damage control surgery.

Four, one, and two patients developed seroma, skin necrosis, chronic pain, and post-surgical wound infection, respectively. No recurrent herniation was recorded during the median follow-up of 5 years.

This technique effectively restores large midline abdominal wall defects with good aesthetic outcomes, minimal complications, and no hernia recurrence during follow-up.