Anterior component separation for complex ventral hernias: outcomes of a tailored reconstruction strategy

To evaluate the outcomes of two open ventral hernia reconstruction strategies selected according to defect complexity, with particular emphasis on postoperative morbidity and recurrence-related reoperations.

This retrospective cohort study included 266 patients who underwent elective ventral hernia repair between 2020 and 2024. Patients underwent either anterior component separation or primary fascial closure with onlay polypropylene mesh reinforcement according to defect complexity and the feasibility of achieving tension-free midline fascial closure. Postoperative complications occurring within 30 days and recurrence-related reoperations during follow-up were analyzed.

A total of 266 patients were included, comprising 90 patients in the component separation group and 176 patients in the primary closure group. Patients undergoing component separation had substantially larger fascial defects (median 150 cm² vs. 25 cm², p < 0.001). Operative time and intraoperative blood loss were significantly higher in the component separation group. Overall postoperative complications occurred more frequently following component separation (15.6% vs. 9.1%, p = 0.04), mainly because of a higher incidence of wound infection (11% vs. 4%, p = 0.03). Recurrence-related reoperation rates were comparable between groups (13.3% vs. 13.1%, p = 0.92). Median follow-up was 48 months (IQR 36-60).

Anterior component separation was preferentially used in patients with larger and more complex ventral hernias. Although early wound morbidity was more frequent in these patients, recurrence-related reoperation rates remained comparable to those achieved with primary fascial closure and onlay mesh reinforcement. These findings support anterior component separation as an effective reconstructive option for achieving durable tension-free midline closure in selected patients with complex ventral hernias.