Abstract
IntroductionThe component separation technique (CST) was introduced to abdominal wall reconstruction to treat large, complex hernias. It is very difficult to compare the published findings because of the vast number of technical modifications to CST as well as the heterogeneity of the patient population operated on with this technique.Material and MethodsThe main focus of the literature search conducted up to August 2017 in Medline and PubMed was on publications reporting comparative findings as well as on systematic reviews in order to formulate statements regarding the various CSTs.ResultsCST without mesh should no longer be performed because of too high recurrence rates. Open anterior CST has too high a surgical site occurrence rate and henceforth should only be conducted as endoscopic and perforator sparing anterior CST. Open posterior CST and posterior CST with transversus abdominis release (TAR) produce better results than open anterior CST. To date, no significant differences have been found between endoscopic anterior, perforator sparing anterior CST and posterior CST with transversus abdominis release. Robot-assisted posterior CST with TAR is the latest, very promising alternative. The systematic use of biologic meshes cannot be recommended for CST.ConclusionCST should always be performed with mesh as endoscopic or perforator sparing anterior or posterior CST. Robot-assisted posterior CST with TAR is the latest development.
Highlights
The component separation technique (CST) was introduced to abdominal wall reconstruction to treat large, complex hernias
Likewise excluded were studies with n < 10 patients or with highly specific key questions which did not appear to lend themselves for literature comparison purposes (e.g., case reports, parastomal hernias, purely experimental studies, pediatric abdominal wall defects, studies with exclusively post-traumatic abdominal wall defects, CST performed in the setting of hyperthermic intraperitoneal chemotherapy (HIPEC) or CST conducted essentially in conjunction with flap surgery)
Warren et al (34) compared 103 standard laparoscopic ventral hernia repairs with 53 robotic posterior CST with transversus abdominis release (Table 1)
Summary
The component separation technique (CST) was introduced for abdominal wall reconstruction to treat large, complex hernias (1). The options for closing large and complex abdominal wall defects, including primary repair, mesh, and distant muscle flaps, have yielded suboptimal results (1). Albanese and Ramirez first developed the CST to address this issue (2–6). “CST is based on the concept of re-establishing a functional abdominal wall with autologous tissue repair” (1). “The procedure involves dividing the relatively fixed external oblique aponeurosis and muscle, elevating the rectus abdominis muscle from its posterior rectus sheath, and mobilizing the myofascial flap consisting of the rectus, internal oblique, and transversus abdominis medially” (1)
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