Related Experiment Video
Updated: May 13, 2026
10:52
Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh
Published on: September 11, 2021
Perforator-sparing component separation reduces lateral pseudo-bulging in large incisional hernia repair
Medeni Şermet1, Salih Tosun2, Leyla Zeynep Tigrel2
1Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Department of General Surgery, Istanbul Medeniyet University, Dr. Erkin Street No. 3, Kadikoy, Istanbul, 34732, Turkey. medeni.sermet@medeniyet.edu.tr.
Summary
Minimally invasive anterior component separation (MIACS) with self-gripping mesh (SGM) onlay significantly reduces wound complications and lateral pseudo-bulging in large incisional hernia repair. Recurrence rates remain comparable to conventional methods.
Area of Science:
- Hernia Surgery
- Minimally Invasive Surgery
- Surgical Mesh Technology
Background:
- Large incisional hernias present complex repair challenges, often involving anterior component separation (ACS).
- Minimally invasive anterior component separation (MIACS) offers a less invasive approach, but its optimal mesh reinforcement strategy requires investigation.
- Wound complications and lateral pseudo-bulging are significant concerns in incisional hernia repair.
Purpose of the Study:
- To compare a three-piece self-gripping mesh (SGM) onlay following MIACS versus conventional ACS with midline-only SGM onlay.
- To evaluate wound complication rates as the primary outcome.
- To assess CT-confirmed lateral pseudo-bulging as a secondary outcome.
Main Methods:
- Single-centre retrospective analysis of prospectively collected data from January 2020 to January 2024.
- Analysis included 79 patients (MIACS n=41; conventional ACS n=38) with an average follow-up of 28 months.
- Primary endpoint was the 24-month wound complication rate; secondary outcomes included pseudo-bulging, seroma, haematoma, and recurrence.
Main Results:
- The MIACS group showed a significantly lower overall wound complication rate (19.5% vs. 44.7%, p=0.012).
- Deep necrotic surgical site infection was absent in the MIACS group compared to 21.1% in the conventional ACS group (p<0.001).
- Lateral pseudo-bulging was significantly reduced in the MIACS group (4.9% vs. 21.1%, p=0.001), with lower intraoperative blood loss and antibiotic requirements.
Conclusions:
- Three-piece SGM onlay following MIACS substantially prevents lateral pseudo-bulging and dramatically reduces wound morbidity, especially deep necrotic infections.
- The MIACS approach with SGM onlay does not negatively impact hernia recurrence rates (4.9% vs. 5.3%, p=1.000).
- This study provides the first comparative evidence supporting linea semilunaris mesh reinforcement as an adjunct to MIACS for large incisional hernia repair.
