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Endoscopic anterior component separation: a novel technical approach.

B Dauser1, S Ghaffari2, C Ng3

  • 1Department of Surgery, St John of God Hospital, Johannes von Gott Platz 1, 1020, Vienna, Austria. b.dauser@hotmail.com.

Hernia : the Journal of Hernias and Abdominal Wall Surgery
|September 25, 2017
PubMed
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This study introduces a modified endoscopic anterior component separation technique using a trocar system. This approach may reduce wound complications in patients with large abdominal wall defects, even in those with obesity.

Area of Science:

  • Minimally Invasive Surgery
  • Abdominal Wall Reconstruction
  • Surgical Techniques

Background:

  • Open anterior release for large abdominal wall defects involves significant morbidity due to extensive dissection.
  • Endoscopic techniques can minimize wound complications but face challenges in identifying entry points, especially in obese patients.
  • A need exists for improved endoscopic methods for anterior component separation.

Purpose of the Study:

  • To present a technical modification for endoscopic anterior component separation.
  • To describe a novel trocar system facilitating blunt and sharp dissection under direct vision.
  • To report initial experience and learning curve with this new approach.

Main Methods:

  • A novel technique for endoscopic anterior component separation using a specialized trocar system was developed.
Keywords:
Endoscopic component separationVentral hernia repair

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  • The system allows for blunt and sharp dissection under direct endoscopic vision.
  • Initial clinical experience and learning curve were documented.

    • Main Results:

    • Endoscopic release of the external oblique fascia was successfully performed in 15 patients (29 procedures).
    • The median body mass index was 30.8 kg/m² (range 21.6-42.5), and the median midline defect width was 7 cm (range 4-12 cm).
    • All cases achieved successful hernia repair with mesh reinforcement; one hematoma occurred and was managed conservatively.

    Conclusions:

    • The described trocar system offers a viable option for endoscopic anterior component separation.
    • This technique may facilitate dissection and potentially reduce complications in abdominal wall reconstruction.
    • Further evaluation is warranted to confirm the benefits and learning curve of this approach.