Components separation technique in treatment of patients with ventral and incisional hernias (Review)

Abstract

There have been considered the failure origin of hernia repair in a certain group of patients with large ventral and incisional hernias. We have demonstrated why a number of current standard techniques cannot be successfully applied in these cases; and shown one of new and promising solutions of the problem. There have been considered the important aspects of an abdominal wall reconstruction with using the components separation technique (CST) in surgical management of ventral and incisional hernias according to data reported in foreign and Russian literature. A point of view of leading researchers on the indications for separation repair has been presented. CST methods are classified, their fundamental differences being shown. There have been described the technical aspects of performing an anterior and posterior separation, as well as the most interesting modifications significant for a surgeon. The key points of the surgical techniques suggested by the method developers have been shown, and the existing CST modifications have been considered, their advantages and disadvantages being emphasized. Special attention has been given to the technologies combining CST and prosthetic repair. We have assessed the role of these surgeries for the closure of large midline defects of an abdominal wall. There have been specified particular characteristics of surgical procedures depending on an approach, the structures of an abdominal wall to be separated, the mesh position in relation to the hernial orifice and anatomic abdominal wall layers, the transfer of self tissues. We have specified the ways to solve a number of important problems in the management of patients with large ventral and incisional hernias with the abdominal cavity volume reduction.