Complex Hernia Repair

This is one of the most challenging surgeries a surgeon can perform. Any hernia defect over 8 cm can fall into this category. In the past, this operation was plagued with major complications and high recurrence rates. The one known principle in hernia repair is that the best repair is always the first one and each attempt decreases the odds of a successful repair. Increasing numbers of patients have large or complex abdominal wall defects such as giant abdominal wall hernias. These may result from an incisional hernia due to multiple abdominal operations, surgical resection of the abdominal wall or necrotizing abdominal wall infections. Management of complex hernias are more difficult to repair and often have higher rates of recurrence and other complications. To manage these complex hernias, component separation is one technique that can aid in the repair of these difficult hernias. It is particularly used when there is insufficient muscular wall that can be pulled back together during a conventional hernia repair. Component separation involves separating and advancing certain layers of the abdominal wall muscle, lengthening them so that the right and left sided muscles can be brought closer to the mid-line for sufficient closure. This technique restores the structural and functional integrity of the abdominal wall and aesthetic appearance. A combination of component separation and mesh repair is frequently used to repair giant abdominal wall hernias. Component separation is a complex procedure that is best done in the hands of experienced surgeons, and it is a technique we commonly use. This technique has changed the way hernias should be done and has show great success rates. This technique is now becoming the gold standard for complex hernia repair. This surgery is often a very long and very technically challenging surgery. This is why few surgeons perform this operation. The name of this operation is called : Posterior Component Separation Technique with Transversus Abdominis Muscle Release.