Going beyond traditional methods: Dual component separation in giant incisional hernia surgery: A case report

Abstract

Large ventral hernias, often with significant defects and loss of domain, present a challenge even for experienced surgeons. Traditionally, surgical management of large incisional hernias involves tension-free mesh repair, either via open or laparoscopic methods. Bridging these defects has involved artificial prostheses. However, failure to close the midline can lead to adverse effects on posture, respiration, micturition, defecation, and overall biomechanical function, severely affecting the patient’s quality of life. Albanese et al. first proposed a model for abdominal wall component separation in 1951, which was later refined by Ramirez et al. in 1990 through a cadaveric study. This technique offers a novel approach to closing midline defects by utilizing native, vascularized tissue—either alone or in combination with prosthetic materials. Over time, this technique has evolved, incorporating various modifications, including anterior and posterior component separation. Component separation has become more widely used, with ongoing modifications aimed at addressing the key challenges of the technique. Hence, here we present a case of a 42-year-old male with a large ventral hernia at the site of midline abdominal surgery performed a decade earlier. The hernia was successfully repaired using a combination of anterior and posterior (dual) component separation techniques, complemented by mesh reinforcement, resulting in a satisfactory outcome and restoring the patient’s functional capacity and quality of life. In conclusion, for complex cases, dual component separation techniques may be used to facilitate defect closure, ensuring abdominal wall integrity and promoting recovery while minimizing complications and recurrence.

Keywords

Case report / dual component separation technique (dCST) / giant incisional hernia / midline abdominal surgery / ventral hernias

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International Journal of Abdominal Wall and Hernia Surgery | Published by Wolters Kluwer - Medknow on behalf of Higher Education Press