title: Laparoscopic versus open-component separation: a comparative analysis in a porcine model.
abstract: BACKGROUND
  The ideal surgical treatment for complicated ventral hernias remains elusive. Traditional component separation provides local advancement of native tissue for tension-free closure without prosthetic materials. This technique requires an extensive subcutaneous dissection with division of perforating vessels predisposing to skin-flap necrosis and complicated wound infections. A minimally invasive component separation may decrease wound complication rates; however, the adequacy of the myofascial advancement has not been studied.
  
  
  METHODS
  Five 25-kg pigs underwent bilateral laparoscopic component separation. A 10-mm incision was made lateral to the rectus abdominus muscle. The external oblique fascia was incised, and a dissecting balloon was inflated between the internal and external oblique muscles. Two additional ports were placed in the intermuscular space. The external oblique was incised from the costal margin to the inguinal ligament. The maximal abdominal wall advancement was recorded. A formal open-component separation was performed and maximal advancement 5 cm superior and 5 cm inferior to the umbilicus was recorded for comparison. Groups were compared using standard statistical analysis.
  
  
  RESULTS
  The laparoscopic component separation was completed successfully in all animals, with a mean of 22 min/side. Laparoscopic component separation yielded 3.9 cm (SD 1.1) of fascial advancement above the umbilicus, whereas 4.4 cm (1.2) was obtained after open release (P = .24). Below the umbilicus, laparoscopic release achieved 5.0 cm (1.0) of advancement, whereas 5.8 cm (1.2) was gained after open release (P = .13).
  
  
  CONCLUSIONS
  The minimally invasive component separation achieved an average of 86% of the myofascial advancement compared with a formal open release. The laparoscopic approach does not require extensive subcutaneous dissection and might theoretically result in a decreased incidence or decreased complexity of postoperative wound infections or skin-flap necrosis. Based on our preliminary data in this porcine model, further comparative studies of laparoscopic versus open component separation in complex ventral hernia repair is warranted to evaluate postoperative morbidity and long-term hernia recurrence rates.
authors: Case Medical Center, University Hospitals of Cleveland, 11100 Euclid Ave., Cleveland, OH 44106, USA. michael.rosen@uhhospitals.org
authors: Michael J
authors: MJ
authors: Rosen
authors: Christina
authors: C
authors: Williams
authors: Judy
authors: J
authors: Jin
authors: Michael F
authors: MF
authors: McGee
authors: Steve
authors: S
authors: Schomisch
authors: Jeffrey
authors: J
authors: Marks
authors: Jeffrey
authors: J
authors: Ponsky
mesh_terms: D000818:Animals; D006555:Hernia, Ventral / Q000601:surgery*; D010535:Laparoscopy; D013514:Surgical Procedures, Operative / Q000379:methods*; D013552:Swine