Increasing numbers of patients have large or complex abdominal wall defects such as giant abdominal wall hernias or enterocutaneous fistulas where bacterial contamination is present. These may result from from an incisional hernia due to multiple abdominal operations, surgical resection of the abdominal wall or necrotizing abdominal wall infections. Management of complex hernias are more difficult to repair and often have higher rates of recurrence and other complications.
To manage these complex hernias, component separation is one technique that can aid in the repair of these difficult hernias. It is particularly used when there is insufficient muscular wall that can be pulled back together during a conventional hernia repair. Component separation involves separating and advancing certain layers of the abdominal wall muscle, lengthening them so that the right and left sided muscles can be brought closer to the mid-line for sufficient closure. This technique restores the structural and functional integrity of the abdominal wall and aesthetic appearance.
A combination of component separation and mesh repair is frequently used to repair giant abdominal wall hernias. Component separation is a complex procedure that is best done in the hands of experienced surgeons, and it is a technique we commonly use.
The UCSF Hernia Center provides the latest treatments for complex ventral hernias, such as the progressive pneumoperitoneum procedure, a specialized approach for treating particularly large ventral hernias. Our patient outcomes far surpass the national average. Patients with complex ventral hernias treated at UCSF have a recurrence rate of approximately 18 percent, compared to a 30 to 40 percent rate nationally.
For More Information
Ventral Hernia Repair (American College of Surgeons)