Prospective study of midline abdominal incisional hernia repair by component separation technique augmented with prosthetic mesh


  • Ravi Saroha Department of General Surgery, VMMC and Safdarjung Hospital, New Delhi, India
  • Shivani B. Paruthy Department of General Surgery, VMMC and Safdarjung Hospital, New Delhi, India
  • Sunil Singh Department of General Surgery, VMMC and Safdarjung Hospital, New Delhi, India



IAP, CST, Open ventral hernia repair


Background: In our tertiary care hospital, we receive a large number of acute abdomen cases. Raised intra-abdominal pressure (IAP) makes laparostomy mandatory initially and abdominal wall approximation cannot be completed due to compromised state in most cases. Large incisional hernias were seen on complete healing and this study was done to see the feasibility of component separation technique (CST) with mesh augmentation.

Methods: 30 patients were subjected to CST with mesh augmentation. Preoperative defect size mapping, Pre- and post-operative monitoring of IAP were done. Pain scoring by visual analogue scale (VAS), early and late complications was noted. Patients were followed up for 60 months.

Results: CST with mesh augmentation was found to be feasible with 96.77% success rate as no recurrence was noted in follow up. Preoperative average Basal metabolic index was 26.09. Size of defect varied from 17-20×9-16 cm2 (length X width). Seroma seen in 50% of patients was managed without any intervention. Skin necrosis in 6.6% and wound dehiscence in 3.33%, managed with minimal debridement & local wound care respectively. Respiratory compromise and hematoma were not seen and no patient required any active ICU care. Average length of hospital stay was 5.22 days. Close monitoring of IAP in immediate post-operative period was found to be significant.

Conclusion: Physical acceptance of stable abdominal wall gives a psychological boost to patients with early recovery in form of ambulation and early return to work.


Korenkov M, Paul A, Sauerland S, Neugebauer E, Arndt M, Chevrel JP et al, Classification and surgical treatment of incisional hernia. Results of an experts meeting. Langenbecks Arch Surg. 2001;386(1):65-73.

Muysoms FF,Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E et al. Classification of primary and incisional abdominal wall hernias. Hernia. 2009;13(4):407-14.

Yahchouchy-Chouillard E, Aura T, Picone O, Etienne JC, Fingerhut A. Incisional hernias. I. Related risk factors. Dig Surg. 2003;20(1):3-9.

Bloemen A, Van Dooren P, Huizinga BF, Hoofwijk AGM. Randomized clinical trial comparing polypropylene on polydioxane for midline abdominal wall closure. Br J Surg. 2011;98(5):633-9.

Franz MG. The biology of hernia formation. Surg Clin North Am. 2008;88(1):1-15.

Franz MG. The biology of hernias and the abdominal wall. Hernia. 2006;10:462-71.

Jansen PL, Rosch R, Rezvani M, Mertens PR, Junge K, Jasen M et al. Hernia firoblasts lack β-estradiol induced alterations of collagen gene expression. BMC Cell Biol. 2006;7:36.

Wantz GE, Chevrel JP, Flament JB, Kingsnorth A, Schumpelick V, Verhaege P. Incisional hernia: the problem and the cure. J Am Coll Surg. 1999;188; 429-47.

Ausobsky JR, Evans M, Pollock AV. Does mass closure of midline laparotomies stand the test of time? A random control clinical trial. Ann R Coll Surg Engl. 1985;67(3):159-61.

Playforth MJ, Sauven PD, Evans M, Pollock AV. The prediction oh incisional hernias by radio-opaque markers. Ann R Coll Surg Engl. 1986;68(2):82-4.

Pollock AV, Evans M. Early prediction of late incisional hernias. Br J Surg. 1989;76(9):953-4.

Burger JWA, Luijendijk RW, Hop WCJ, Halm JA, Verdaasdonk EGG, Jeekel J. Long-term follow up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg. 2004;240(4):578-83.

Hawn MT, Snyder CW, Graham LA, Gray SH, Finan KR, Vick CC. Long-term follow-up of technical outcomes for incisionalhernia repair. J Am Coll Surg. 2010;210(5):648-55:655-7.

Flum DR, Horvath K, Koepsell T, Have outcomes of incisional hernia repair improved with time? A population- based analysis. Ann Surg. 2003;237(1):129-35.

Helgstrand F, Rosenberg J, Bay-Nielsen M, Andersen HF, Wara P, Jorgensen LN et al. Establishment and initial experiences from the Danish Ventral Hernia Database. Hernia. 2010;14(2):131-5.

Gray SH, Vick CC, Graham LA, Finan KR, Neumayer LA, Hawn MT. Variation in mesh placement for ventral hernia repair:an opportunity for process improvement? Am J Surg. 2008;196(2):201-6.

Courtney CA, Lee AC, Wilson C, O'Dwyer PJ. Ventral hernia repair: a study of current practice. Hernia. 2003;7(1);44-6.

Mazzochi M, Dessy LA, Raul R, Carlesimo B, Rubinco C. Component Separation technique and pannidelectomy for repair of incisional hernia. Am J surg. 2011;201(6):776-83.

Jason HK, Wang EC, Salvay DM, Paul BC, Dumanian GA. Abdominal Wall Reconstruction Lessons Learned From 200 Components Separation Procedures. Arch Surg. 2009;144(11):1047-1055.

Van Geffen HJAA, Simmermacher RKJ. Incisional Hernia Repair: Abdominoplasty, Tissue Expansion, and Methods of Augmentation. World J Surg. 2005;29(8):1080-5.

De Vries Reilingh TS, Goor HV, Charbon JA, Rosman C, Hesselink EJ, Van der Wilt GJ et al. Repair of Giant Midline abdominal wall hernias: Component Separation Technique Vs. Prosthetic Repair. World J Surg. 2007;31(4):756-63.

Lowe JB III, Lowe JB, Baty JD, Garza JR. Risks associated with Components Separation for closure of complex abdominal wall defects. Plast reconstr Surg. 2003;111(3):1276-83.






Original Research Articles