“Components Separation Technique” for Giant Abdominal Wall Defect Repair

Abstract

A 67-year-old female, with a history of steroid use for rheumatoid arthritis, had a partial resection of the small intestine because of intestinal perforation caused by a malignant lymphoma. Postoperatively she developed a wound infection and dehiscence which led to the development of a ventral hernia. Since the hernia repair using a simple closure failed, she was referred to our institution. On admission, a large ventral hernia, 20×9 cm in size, with full-thickness loss of the abdominal wall, 13×9 cm in size, was observed. To avoid the infection risk associated with long-term steroid use, a hernia repair using the components separation technique was planned. At surgery, components separation was performed by incising the aponeurosis of the external oblique muscle longitudinally ; the muscle was then separated from the underlying internal oblique muscle by blunt dissection, to allow the midline closure of the rectus muscle to be done with less tension. The postoperative course was uneventful, and she was discharged on postoperative day 15. She has had no recurrence of the hernia during 21 months of follow-up.