title: A stepwise approach based on a rational use of components separation and double mesh prosthesis for incisional hernia repair.
abstract: OBJECTIVE
  We aimed to evaluate the results of a protocol for a tension-free reconstruction of the abdominal wall in midline incisional hernia repair, based on the rational association of components separation and prosthesis, independently of the hernia size.
  
  
  METHODS
  A total of 100 consecutive patients with midline incisional hernias were prospectively included in the study. Three groups according to the transverse diameter of the defect [group A (<4 cm, N = 18), group B (4-10 cm, N = 59), and group C (>10 cm, N = 23)] were identified.
  
  
  RESULTS
  Components separation was necessary in 54% of the patients: 16.7% (3/18) in group A, 59.3% (35/59) in group B, and 69.6% (16/23) in group C. Complete tension-free reconstruction was achieved in 87% of the patients: 94.4% (17/18) in group A, 91.5% (54/59) in group B, and 69.6% (16/23) in group C. Overall morbidity rate was 21% (21/100) [group A 16.7% (3/18), group B 22% (13/59), and group C 21.7% (5/23)]. Hospital length of stay was 3.7 ± 3.3 days (group A 1.83 ± 1.43 days, group B 3.05 ± 2.11 days, and group C 6.91 ± 4.45 days). Median follow-up was 25 months (interquartile range 12.25-55.25) with overall recurrence of 2%.
  
  
  CONCLUSIONS
  A tension-free abdominal wall reconstruction can be achieved in most cases of small and large midline incisional hernia repair, by a stepwise approach based on a rational association of components separation and double mesh prosthesis, with a low morbidity and recurrence rates.
authors.affiliation: Department of Surgery, Clínica de la Concepción, Hospital Universitario "Fundación Jiménez Díaz", Avda. Reyes Católicos No 2, 28040, Madrid, Spain.
authors.forename: Á
authors.initials: Á
authors.lastname: Celdrán
authors.affiliation: Department of Surgery, Clínica de la Concepción, Hospital Universitario "Fundación Jiménez Díaz", Avda. Reyes Católicos No 2, 28040, Madrid, Spain.
authors.forename: M J
authors.initials: MJ
authors.lastname: Fraile
authors.affiliation: Department of Surgery, Clínica de la Concepción, Hospital Universitario "Fundación Jiménez Díaz", Avda. Reyes Católicos No 2, 28040, Madrid, Spain. tihomir.hristov@gmail.com.
authors.forename: T
authors.initials: T
authors.lastname: Georgiev-Hristov
authors.affiliation: Department of Surgery, Clínica de la Concepción, Hospital Universitario "Fundación Jiménez Díaz", Avda. Reyes Católicos No 2, 28040, Madrid, Spain.
authors.forename: S
authors.initials: S
authors.lastname: González-Ayora
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D000368:Aged; D002985:Clinical Protocols; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D000069290:Incisional Hernia / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000379:methods*; D013526:Surgical Mesh
keywords: Components separation; Incisional hernia; Tension-free hernioplasty