Single port component separation: endoscopic external oblique release for complex ventral hernia repair

Area of Science:

• Minimally Invasive Surgery
• Abdominal Wall Reconstruction
• Hernia Repair

Background:

• Component separation (CS) is a technique for closing large ventral hernias using autologous tissue.
• Traditional CS involves extensive tissue dissection, leading to potential wound complications.
• This study evaluates a new ultra-minimally invasive single port anterior CS technique.

Purpose of the Study:

• To examine the benefits of a novel, ultra-minimally invasive single port anterior component separation technique.
• To assess the safety and efficacy of this technique in patients with recurrent complex ventral hernias.

Main Methods:

• Prospective study involving 16 external oblique (EO) releases in 9 patients and 4 releases in 3 cadavers.
• Patients received preoperative Botulinum Toxin A to facilitate lateral oblique muscle closure.
• Single port endoscopic EO release performed via a single 20-mm incision per side, with measurements using real-time ultrasound.

Main Results:

• Achieved a maximum of 50-mm myofascial advancement per side.
• No wound infections, hematomas, or laxity/bulge complications were observed.
• All patients underwent successful hernia repair with no recurrences to date.

Conclusions:

• Single port endoscopic EO release is a safe, efficient, and minimally disruptive adjunct for large ventral hernia repair.
• The technique preserves abdominal wall vessels and minimizes potential complications.
• Further studies are warranted to quantify advancement gains and morbidity, with and without Botulinum Toxin A.