Anterior versus posterior component separation technique for advanced abdominal wall reconstruction: a proposed...

Area of Science:

• Abdominal wall reconstruction
• Surgical techniques
• Hernia repair

Background:

• Anterior component separation technique (ACST) and Transversus Abdominis Release (TAR) are valuable for abdominal wall reconstruction (AWR).
• Precise indications for ACST and TAR in complex AWR remain unclear.
• This study aimed to compare ACST and TAR outcomes based on an AWR algorithm.

Purpose of the Study:

• To analyze anterior fascial closure rates, postoperative wound morbidity, and hernia recurrence for ACST and TAR.
• To evaluate the effectiveness of these techniques within a defined algorithm for complex AWR.

Main Methods:

• Retrospective analysis of prospectively collected data (March 2013 - August 2022).
• Included patients undergoing AWR for midline incisional hernias using open/endoscopic ACST or TAR.
• Excluded patients with lateral hernia components; technique selection based on hernia width and traction needs.

Main Results:

• 119 patients included: 63 in ACST group, 56 in TAR group.
• High anterior fascial closure rates for both: 95.2% (ACST) vs 98.2% (TAR).
• TAR group showed significantly lower surgical site occurrence (SSO) rates (14.3% vs 44.3%) and fewer interventions (8.9% vs 31.1%). Recurrence rates were similar (1.8% vs 4.5%).

Conclusions:

• Both ACST and TAR achieve high anterior fascial closure rates when used per algorithm.
• TAR is associated with significantly lower postoperative wound morbidity compared to ACST.
• Recommend TAR for defects up to 14 cm and open ACST for larger defects in AWR.