Evaluation of the Component Separation Technique for Treatment of Patients with Large Incisional Hernia


Kunwar Aggarwal


Background: Incisional hernia remains a frequent complication of abdominal surgery. Results of surgical repair are disappointing with recurrence rates of suture repair being in the range of 5–63% depending upon the type of repair used, with better results using mesh implantation. In extreme cases a large hernial defect exists with a “loss of abdominal domain”. In addition, the approximated rectus muscles under tension become hypoper fused leading to atrophy and increased chances of recurrence. For the management of such large hernias, interest has been generated in the “Component Separation Technique”. This technique relaxes abdominal wall by translation of muscular layers without severing the innervation and blood supply, with or without the mesh augmentation. This can accommodate for defects up to 25–30cm in the waistline. However, wound complications are frequent and reported in up to half of the patients. Thus, the study was planned in view of the potential benefits of “CST” and its capability to restore lost abdominal domain. Methods: The study was conducted on 20 patients with “Large Incisional Hernia” with defect size >5cm or with a surface area >50cm2 operated upon with component separation. Outcome was measured over a follow up period of three months in terms of recurrence and other local complications. Result: There were 20 patients [3 men and 17 women; 70% cases above the age of 50years]. Mean defect size was 9.5cm [range = 6–20cm]. Average body mass index was 28.97kg/m2 [range = 22–37kg/ m2]. Mean duration of hospital stay was 9 days [range = 5–21 days]. Early complications occurred in 15% (3/20) cases and post-operative abdominal compartment or recurrence was not reported over a follow up period of 3 months. Conclusions: It is finally concluded that “Large Incisional Hernias” can be effectively treated by “Component Separation Technique”


How to Cite
Aggarwal, K. (2021). Evaluation of the Component Separation Technique for Treatment of Patients with Large Incisional Hernia. International Journal of Medical and Dental Sciences, 2011–2017. https://doi.org/10.18311/ijmds/2021/26738


  1. Mudge M, Hughes LE. Incisional hernia: A 10 year prospective study of incidence and attitudes. Br J Surg. 1985; 72(1):70–1. https://doi.org/10.1002/bjs.1800720127. PMid:3155634.
  2. Lewis RT, Wiegand FM. Natural history of vertical abdominal parietal closure: Prolene versus Dexon. Can J Surg. 1989; 32(3):196-200.
  3. Hoer J, Lawong G, Klinge U, Schumpelick V. Factors influencing the development of incisional hernia. A retrospective study of 2983 laparotomy patients over a period of 10 years. Chirug. 2002; 73(5):474–80.
  4. Prismant. Utrecht, the Netherlands: National Medical Registration; 2002.
  5. Read RC, Yoder G. Recent trends in management of incisional herniation. Arch Surg. 1989; 124:485–8.
  6. https://doi.org/10.1001/archsurg.1989.01410040095022. PMid:2649047.
  7. Korenkov M, Sauerland S, Arndt M, Bograd L, Neugebauer EA, Troidl H. Randomized clinical trial of suture repair, polypropylene mesh or autodermal; hernioplasty for incisional hernia. Br J Surg. 2002; 8991:50–6. https://doi.org/10.1046/j.0007-1323.2001.01974.x. PMid:11851663.
  8. Toniato A, Pagetta C, Bernante P, Piotto A, Pelizzo MR. Incisional hernia treatment with progressive pneumoperitoneum and rertro-muscular prosthetic hernioplasty. Langenbecks Arch Surg. 2002; 387(5-6):246–8. https://doi.org/10.1007/s00423-002-0316-8. PMid:12410362.
  9. Burger JWA, Luijendijk RW, Hop WCJ, Halm JA, Verdaasdonk EGG, Jeekel J. Long term follow up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg. 2004: 240(4):578–83. https://doi.org/10.1097/01.sla.0000141193.08524.e7. PMid:15383785 PMCid:PMC1356459.
  10. Ramirez OM, Ruas E, Lee Dellon A. Component Separation Method for closure of abdominal wall defects: An Anatomic and clinical study. Plast Reconstr Surg. 1990; 86:519–26. https://doi.org/10.1097/00006534199009000-00023. PMid:2143588.
  11. De Vries Reilingh TS, van Goor H, Rosman C, Bemelmans MH, de Jong D, van Nieuwenhoven EJ, et al. Component separation technique for the repair of large abdominal wall hernias. J Am Coll Surg. 2003; 196:32–7. https://doi.org/10.1016/S1072-7515(02)01478-3.
  12. van Geffen HJAA, Simmermadner RKJ, van Vroonhoven TJMV, van der Werken C. Surgical treatment of large contaminated abdominal wall defects. J Am Coll Surg. 2005; 201:206–12. https://doi.org/10.1016/j.jamcollsurg.2005.03.030. PMid:16038817.
  13. Bleichrodt R, De Vries Reilingh TS, Malyar A, Van Goor H, Hansson B, Van der Kolk B. Component separation technique to repair large midline hernias. Oper Tech Gen Surg. 2004; 6(3):179–88. https://doi.org/10.1053/j.optechgensurg.2004.07.001.
  14. Samir M, Hany M, Ibrahim M. Evaluation of component separation technique in the repair of complex large ventral hernia with large defects. Egypt J Surg. 2015; 34:272–5. https://doi.org/10.4103/1110-1121.167390.
  15. Sailes FC, Walls J, Guelig D, Mirzabeigi M, Long WD, Crawford A, et al. Synthetic and biological mesh in component separation: A 10 yr. Single institution review. Ann Plast Surg. 2010; 64: 696–8. https://doi.org/10.1097/SAP.0b013e3181dc8409. PMid:20395790.
  16. Hultman CS, Tong WM, Kittinger BJ, Cairns B, Overby DW, Rich PB. Management of recurrent hernia after components separation: 10-year experience with abdominal wall reconstruction at an academic medical center. Ann Plast Surg. 2011; 66:504–7. https://doi.org/10.1097/SAP.0b013e31820b3d06. PMid:21451379