Henares University Hospital (Coslada, Madrid), Faculty of Health Sciences, Francisco de Vitoria University, Carretera Pozuelo-Majadahonda km. 1,800, 28223, Pozuelo de Alarcón, Spain.
Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain.
Hernia. 2020 Apr;24(2):369-379. doi: 10.1007/s10029-020-02152-3. Epub 2020 Mar 5.
The closure of midline in abdominal wall incisional hernias is an essential principle. In some exceptional circumstances, despite adequate component separation techniques, this midline closure cannot be achieved. This study aims to review the results of using both anterior and component separation in these exceptional cases.
We reviewed our experience using the combination of both anterior and posterior component separation in the attempt to close the midline. Our first step was to perform a TAR and a complete extensive dissection of the retromuscular preperitoneal plane developed laterally as far as the posterior axillary line. When the closure of midline was not possible, an external oblique release was made. A retromuscular preperitoneal reinforcement was made with the combination of an absorbable mesh and a 50 × 50 polypropylene mesh.
Twelve patients underwent anterior and posterior component separation. The mean hernia width was 23.5 ± 5. The majority were classified as severe complex incisional hernia and had previous attempts of repair. After a mean follow-up of 27 months (range 8-45), no case of recurrence was registered. Only one patient (8.33%) presented with an asymptomatic bulging in the follow-up. European Hernia Society's quality of life scores showed a significant improvement at 2 years postoperatively in the three domains: pain (p = 0.01), restrictions (p = 0.04) and cosmetic (p = 0.01).
The combination of posterior and anterior component separation can effectively treat massive and challenging cases of abdominal wall reconstruction in which the primary midline closure is impossible to achieve despite appropriate optimization of surgery.
关闭腹壁切口疝的中线是一个基本原则。在某些特殊情况下，尽管采用了适当的分离技术，仍无法实现中线关闭。本研究旨在回顾使用前侧和后侧分离技术治疗这些特殊情况的结果。
我们回顾了使用前侧和后侧分离技术联合治疗以试图关闭中线的经验。我们的第一步是进行 TAR，并彻底广泛地分离横向扩展到后腋线的腹直肌后筋膜前间隙。当无法关闭中线时，进行外斜肌松解。采用可吸收网片和 50×50 聚丙烯网片组合进行腹直肌后筋膜前间隙加固。
12 例患者接受了前侧和后侧分离技术。平均疝宽为 23.5±5。大多数患者被归类为严重复杂的切口疝，并曾尝试过修复。平均随访 27 个月（8-45）后，无复发病例。仅 1 例患者（8.33%）在随访中出现无症状隆起。欧洲疝学会的生活质量评分显示，术后 2 年在疼痛（p=0.01）、限制（p=0.04）和美容（p=0.01）三个方面均有显著改善。
后侧和前侧分离技术的联合应用可以有效地治疗巨大和具有挑战性的腹壁重建病例，这些病例尽管经过适当的手术优化，仍无法实现主要的中线关闭。
