Hernia Center, Vivantes Humboldt Hospital, Academic Teaching Hospital of Charité University Medicine, 13509, Berlin, Germany.
Hernia. 2024 Jun;28(3):711-721. doi: 10.1007/s10029-024-02994-1. Epub 2024 Mar 28.
Incisional hernias with a defect width of more than10 cm are considered complex. The European Hernia Society guidelines recommend that such hernias should only be repaired by surgeons with experience of component separation. The standard component separation technique now is posterior component separation with transversus abdominis release (PCSTAR). Questions are raised about the limits of this technique.
A literature search of publications on PCSTAR was performed for any references to the limits of this technique in open incisional hernia repair. We found 26 publications relevant to answer this research questions.
The standard PCSTAR can generally be used for a defect width of up to 15-17 cm. For defects greater than 17 cm problems must be expected with procedural tasks involving closure of the posterior layer and anterior fascia. No data are available in the literature on the bridging rate for the posterior layer. However, our own experiences show that gaps (holes) occur in the very thin peritoneum/fascia transversalis during dissection and these must be carefully closed. Furthermore, bridging with an absorbable synthetic mesh is needed not so rarely. Closure of the anterior fascia is successful in 81.0-97.2% of cases. In addition to a further mesh for anterior fascial closure, the hernia sac bound with multiple, accordion-like stitches can also be used. For a defect width greater than 17 cm, the limits of PCSTAR become increasingly evident and can be overcome through special technical solutions for closure of the posterior layer and the anterior fascia.
缺损宽度超过 10cm 的切口疝被认为是复杂的。欧洲疝学会指南建议，只有具有分离技术经验的外科医生才能修复此类疝。目前标准的分离技术是经腹横肌后分离和横腹(transversus abdominis release，TAR)（PCSTAR）。但对该技术的局限性存在质疑。
对 PCSTAR 相关出版物进行文献检索，以查找关于开放性切口疝修复中该技术局限性的任何参考文献。我们找到了 26 篇与回答这个研究问题相关的出版物。
标准的 PCSTAR 通常可用于缺损宽度达 15-17cm 以内的病例。对于大于 17cm 的缺损，在进行后层和前筋膜关闭等操作时必须考虑到可能出现的问题。在文献中，尚无关于后层桥接率的数据。然而，我们自己的经验表明，在分离过程中，非常薄的腹膜/横筋膜(transversalis fascia)会出现间隙（孔），必须仔细关闭。此外，并非罕见情况下需要使用可吸收合成补片进行桥接。前筋膜的关闭成功率为 81.0-97.2%。除了用于前筋膜关闭的另一个补片外，还可以使用多个类似手风琴的缝合线绑定疝囊。对于缺损宽度大于 17cm 的病例，PCSTAR 的局限性变得越来越明显，可以通过后层和前筋膜关闭的特殊技术解决方案来克服。
