Versorgung ventraler Riesenhernien unter Verwendung einer modifizierten Komponenten-Separationstechnik

Abstract

Closure of Ventral Giant Hernias through Modified Component Separation Technique Incisional hernias are a fairly common complication of median laparotomies. They appear in about 10% of all cases. Repair techniques without net inlay are associated with a recurrence rate up to 50%. Therefore, procedures using surgical meshes in sublay technique became the method of choice. Very large abdominal wall defects, commonly due to laparostoma techniques, including laterality of the rectus muscle require an extended operative procedure. During the last 2 years, 8 patients between 24 and 74 years of age underwent repair of a ventral giant hernia at our department. The vertical and horizontal diameters of these hernias ranged from 10 to 24 cm. In 4 cases a mesh-grafted intestinal prolaps occurred after previous laparostoma procedure. Our operative technique includes the classical steps of component separation with incision of the external oblique muscle origin combined with implantation of a surgical mesh behind the rectus muscle (sublay technique). Mesh grafts over the intestines are de-epithelialized using a CO₂ laser in order to save operating time and to prevent unnecessary blood loss. The dermal remnants are then placed underneath the dorsal rectus sheath. Postoperative complications included delayed wound healing and temporary seroma formation in 1 patient. In a second case a slowly progressive and hardly symptomatic hernia superior to the right iliac crest occurred 11 months postoperatively. There was no recurrence of a surgically treated ventral hernia during a mean follow-up of 11 months. Tension-free closure of large midline defects is managed through component separation technique. Thus, the anatomy of the abdominal wall and its dynamic competence are restored. Laser vaporization of mesh-grafted areas decreases the operating time, the blood loss, and the risk of intestinal lesions. In addition, risk of hernia recurrence is supposed to substantially be reduced using the additional net sublay technique.