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Component separation technique for a very large abdominal wall hernia
• 28 years male.• Abdominal distention since 1 month.• P/A- Large Ventral Hernia with widely gappingrecti muscles, thinning of overlying skin, grossabdominal distention.• Past history: Ileostomy and Colostomy formegacolon with Crohn’s Colitis followed by closureof stoma.
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Planned for Incisional hernia repair (component separation technique)
with mesh
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Step 1. Incision planning Skin incision is planned considering the size of the defect and
the laxity of the overlying skin.
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Step 2. Lateral dissection• Extensive lateral dissection is done on both sides beyond
the rectus muscle to expose the external oblique aponeurosis.
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Step 3. Bilateral Lateral Incision on external oblique aponeurosis
Long vertical incisions areplaced on both sidesstarting from costalmargin up to the pelvicbone inferiorly on bothsides.
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Step 4. Dissection between external and internal oblique muscles
• Extensive blunt dissection done in between the two muscles in an avascular plane to separate the components and gain 7-10 cm medial shift of the anterior component.
• If necessary posterior incision on posterior rectus sheath can also be placed to further gain a shift of 3-4 cm.
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Step 5. Midline mass closure with interrupted sutures
Midline closure wasdone without tensionwith interrupted nonabsorbable no 1sutures
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Step 6. Overlay repair with Polypropelene mesh
A large piece ofpolypropylene mesh (30* 15 cm) is placed overthe repair to have anadequate cover andoverlap all around thedefect and fixed toparities with sutures.
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Step 7 Closure with negative suction drains
Post-operative Course
• Liquids were started on 2nd POD.• Semisolid diet on 3rd POD and normal diet on 4th POD.• Drains removed on 7th POD. • Discharged on 7th POD.
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Conclusion
• Component separation technique is an excellent technique for large ventral central defects which can allow a medial shift of approx. 10 cm on each side to cover the defect without tension.
• An overlay mesh repair is performed to reinforce the mass closure
• This technique can prevent intra-abdominal compartment syndrome and postoperative pain and can allow tension free repair of large hernias