title: Preliminary experience and development of an algorithm for the optimal use of the laparoscopic component separation technique for myofascial advancement during ventral incisional hernia repair.
abstract: BACKGROUND
  Component separation technique (CST) enables rectus abdominus medialization, but may cause wound complications. Few published outcomes exist involving laparoscopic CST. Our aim was to examine feasibility and outcomes involving open and laparoscopic (lap) CST during ventral incisional hernia repair (VIHR) and present an algorithm for ventral herniorrhaphy.
  
  
  METHODS
  Our design was a retrospective cohort study. Over 22 months, 28 patients underwent one of the following: (i) unilateral (U-) lap CST with open VIHR [n = 5], (ii) bilateral (B-) lap CST with open VIHR [n = 7], (iii) B-lap CST with lap VIHR [n = 8], or (iv) B-open CST with open VIHR [n = 8]. Indications for open VIHR included mesh removal, concomitant visceral procedure, wound revision, thin/ulcerated skin, abdominal wall tumor, frozen abdomen, and/or off-midline hernia. During open VIHR, CST was performed in the Ramirez fashion. Lap CST was performed before intraperitoneal access in lap VIHR and after retrorectus dissection in open VIHR. Patient surveillance consisted of clinical encounters and telephone interviews.
  
  
  RESULTS
  Groups were similar regarding age, body mass index, American Society of Anesthesiologists classification, hernia width, operative time, and hospital stay. Six of the 20 patients who underwent open VIHR developed wound complications, and two required early reoperation. Four of the six with concomitant visceral procedures had wound complications. No laparoscopic VIHR patients had a wound complication. Based on 11 months' follow-up, one open VIHR patient has concern for recurrence.
  
  
  CONCLUSIONS
  Laparoscopic CST is feasible during open and laparoscopic VIHR, but it appears most beneficial for wound healing after laparoscopic VIHR. During open VIHR, laparoscopic CST may not substantially reduce wound complications.
authors.affiliation: Department of Surgery, Mayo Clinic Florida, Jacksonville, Florida 32224, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Parker
authors.forename: Jillian M
authors.initials: JM
authors.lastname: Bray
authors.forename: Jason M
authors.initials: JM
authors.lastname: Pfluke
authors.forename: Horacio J
authors.initials: HJ
authors.lastname: Asbun
authors.forename: C Daniel
authors.initials: CD
authors.lastname: Smith
authors.forename: Steven P
authors.initials: SP
authors.lastname: Bowers
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D000368:Aged; D000465:Algorithms; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies