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Toma M, Oprea V, Grad O, Staines H, Bucuri CE, Andercou O, Gherghinescu M, Molnar C. Early outcomes of open anterior versus posterior components separation with transversus abdominis release for large median incisional hernias: a retrospective stepwise analysis. Hernia 2024; 28:803-813. [PMID: 37975991 DOI: 10.1007/s10029-023-02920-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/22/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Complex incisional hernia is still a debatable topic, with increasing incidence and an increased local and systemic postoperative morbidity and mortality. The size of the defect is a risk factor for both difficult closure and 30-day readmission due to complications. The main option for closure such defect is a mesh augmented component separation technique. The goal was to evaluate 30-day wound events and general complications including 90 days mortality. MATERIAL AND METHODS We present a retrospective study that includes patients from two different university hospitals who underwent open incisional hernia repair with anterior component or posterior component separation between January 2015 and December 2021. Only non-contaminated adult patients (over 18 years old) with postoperative primary or recurrent median abdominal wall defects larger than 6 cm and with complete fascial closure were included. Demographics (age, gender, Body Mass Index-BMI, American Society of Anesthesiologists Classification-ASA score), recurrence rank, and co-morbidities), operative details, patient outcomes complications were collected. A native abdomen/pelvis computerized tomography (CT) scan was performed preoperatively in all patients and the anatomy of the defect and volumetry (abdominal cavity volume, incisional hernia volume and peritoneal volume) were evaluated. One of the component separation technique was performed according to Carbonell's equation. RESULTS Two hundred and two patients (101 from each group) were included. The patients with posterior component separation were more comorbid and with larger defects. The procedure was longer with 80 min but overall length of hospital stay shorter (p < 0.001) for posterior component separation. Seroma, hematoma and skin necrosis were equally distributed for both group of patients and there was no direct relation to surgery (OR 0.887, 95% CI 0.370-2.125, p = 0.788; OR 1.50, 95% CI 0.677-3.33, p = 0.318 and OR 0.386, 95% CI 0.117-1.276, p = 0.119). Surgical Site Infection rate was increased for anterior component separation (p =0.004). CONCLUSION Complex incisional hernia repair is a challenge given by a large amount of wound complications. Choosing between anterior and posterior component separation is still a source of significant debate. We were not able to depict significant different rates of complications between the procedures and we couldn't find any specific factor related to complications.
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Affiliation(s)
- Mihai Toma
- Clinical Department of Surgery, "Constantin Papilian" Emergency Clinical Military Hospital, Cluj-Napoca, 22 G-ral Traian Mosoiu, Cluj-Napoca-Napoca, Romania
- "George Emil Palade" University of Medicine, Pharmacy, Science and Technology, Targu-Mures, Romania
| | - Valentin Oprea
- Clinical Department of Surgery, "Constantin Papilian" Emergency Clinical Military Hospital, Cluj-Napoca, 22 G-ral Traian Mosoiu, Cluj-Napoca-Napoca, Romania.
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca-Napoca, Romania.
| | - Ovidiu Grad
- Clinical Department of Surgery, "Constantin Papilian" Emergency Clinical Military Hospital, Cluj-Napoca, 22 G-ral Traian Mosoiu, Cluj-Napoca-Napoca, Romania
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca-Napoca, Romania
| | | | - Carmen E Bucuri
- Clinical Department of Surgery, "Constantin Papilian" Emergency Clinical Military Hospital, Cluj-Napoca, 22 G-ral Traian Mosoiu, Cluj-Napoca-Napoca, Romania
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca-Napoca, Romania
| | - Octavian Andercou
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca-Napoca, Romania
- Second Clinical Department of Surgery, Emergency Clinical County Hospital, Cluj-Napoca-Napoca, Romania
| | - Mircea Gherghinescu
- "George Emil Palade" University of Medicine, Pharmacy, Science and Technology, Targu-Mures, Romania
- First Clinical Department of Surgery, Emergency Clinical County Hospital, Targu-Mures, Romania
| | - Calin Molnar
- "George Emil Palade" University of Medicine, Pharmacy, Science and Technology, Targu-Mures, Romania
- First Clinical Department of Surgery, Emergency Clinical County Hospital, Targu-Mures, Romania
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Dries P, Verstraete B, Allaeys M, Van Hoef S, Eker H, Berrevoet F. Anterior versus posterior component separation technique for advanced abdominal wall reconstruction: a proposed algorithm. Hernia 2024; 28:895-904. [PMID: 38652204 DOI: 10.1007/s10029-024-03039-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE The precise indications for employing the anterior component separation technique (ACST) and the Transversus Abdominis Release (TAR) in abdominal wall reconstruction (AWR) remain uncertain, despite the undeniable value of both techniques. The aim of this study was to analyze the anterior fascial closure rate, postoperative wound morbidity, and hernia recurrence rate for both procedures according to the algorithm used for complex AWR. METHODS A retrospective analysis of prospectively collected data was carried out. Patients undergoing AWR for midline incisional hernias using either open or endoscopic ACST (E-ACST) or TAR between March 2013 and August 2022 were included. Patients with lateral hernia components were excluded. The surgical technique was depending on the pre- and intraoperative findings regarding hernia width and on the estimated traction to achieve anterior fascial closure (see algorithm). Initially, intermediate hernia defects ranging from approximately 10-14 cm in width were repaired using E-ACST. However, as the study advanced, TAR became the preferred method for addressing these types of defects. Open ACST was consistently employed for defects wider than 14-15 cm throughout the entire study duration. Outcomes of interest were anterior fascial closure, surgical site occurrences, and hernia recurrence rate. Follow-up was performed at 1 month, 1 year, and 2 years. RESULTS A total of 119 patients underwent AWR with CST: 63 patients (52.9%) were included in the ACST group and 56 patients (47.1%) in the TAR group. No significant differences were observed in patient and hernia characteristics. The use of botulinum toxin A (BTA) injection and preoperative progressive pneumoperitoneum (PPP) was more frequently used in the ACST group (BTA 19.0%, PPP 15.9% versus BTA 5.4%, PPP 1.8% for TAR patients). Anterior fascial closure was achieved in 95.2% of the ACST group and 98.2% of the TAR group (p = 0.369). The TAR group demonstrated a significantly lower SSO rate at one month (44.3% versus 14.3%, p < 0.001) and required fewer procedural interventions (SSO-PI) (31.1% versus 8.9%, p = 0.003). The recurrence rate at one year was low and there was no statistically significant difference between the two groups (ACST 1.8% vs TAR 4.5%, p = 0.422). CONCLUSION Following a proposed algorithm, the anterior fascial closure rate was high and similar for both techniques. As postoperative wound morbidity is significantly increased after ACST, our findings support recommending TAR for defects up to 14 cm in width, while favoring open ACST for larger defects.
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Affiliation(s)
- P Dries
- Department for General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium.
| | - B Verstraete
- Department for General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - M Allaeys
- Department for General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - S Van Hoef
- Department for General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - H Eker
- Department for General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - F Berrevoet
- Department for General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
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Miller BT, Ellis RC, Petro CC, Krpata DM, Prabhu AS, Beffa LRA, Huang LC, Tu C, Rosen MJ. Quantitative Tension on the Abdominal Wall in Posterior Components Separation With Transversus Abdominis Release. JAMA Surg 2023; 158:1321-1326. [PMID: 37792324 PMCID: PMC10551814 DOI: 10.1001/jamasurg.2023.4847] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/16/2023] [Indexed: 10/05/2023]
Abstract
Importance Posterior components separation (PCS) is a commonly used myofascial release technique in ventral hernia repairs. The contribution of each release with anterior and posterior fascial advancement has not yet been characterized in patients with ventral hernias. Objective To quantitatively assess the changes in tension on the anterior and posterior fascial elements of the abdominal wall during PCS to inform surgeons regarding the technical contribution of each step with those changes, which may help to guide intraoperative decision-making. Design, Setting, and Participants This case series enrolled patients from December 2, 2021, to August 2, 2022, and was conducted at the Cleveland Clinic Center for Abdominal Core Health. The participants included adult patients with European Hernia Society classification M1 to M5 ventral hernias undergoing abdominal wall reconstruction with PCS. Intervention A proprietary, sterilizable tensiometer measured the force needed to bring the fascial edge of the abdominal wall to the midline after each step of a PCS (retrorectus dissection, division of the posterior lamella of the internal oblique aponeurosis, and transversus abdominis muscle release [TAR]). Main Outcome The primary study outcome was the percentage change in tension on the anterior and posterior fascia associated with each step of PCS with TAR. Results The study included 100 patients (median [IQR] age, 60 [54-68] years; 52 [52%] male). The median (IQR) hernia width was 13.0 (10.0-15.2) cm. After complete PCS, the mean (SD) percentage changes in tension on the anterior and posterior fascia were -53.27% (0.53%) and -98.47% (0.08%), respectively. Of the total change in anterior fascial tension, retrorectus dissection was associated with a mean (SD) percentage change of -82.56% (0.68%), incision of the posterior lamella of the internal oblique with a change of -17.67% (0.41%), and TAR with no change. Of the total change in posterior fascial tension, retrorectus dissection was associated with a mean (SD) percentage change of -3.04% (2.42%), incision of the posterior lamella of the internal oblique with a change of -58.78% (0.39%), and TAR with a change of -38.17% (0.39%). Conclusions and Relevance In this case series, retrorectus dissection but not TAR was associated with reduced tension on the anterior fascia, suggesting that it should be performed if anterior fascial advancement is needed. Dividing the posterior lamella of the internal oblique aponeurosis and TAR was associated with reduced tension on the posterior fascia, suggesting that it should be performed for posterior fascial advancement.
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Affiliation(s)
- Benjamin T. Miller
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ryan C. Ellis
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Clayton C. Petro
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, Ohio
| | - David M. Krpata
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ajita S. Prabhu
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lucas R. A. Beffa
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chao Tu
- Department of Statistics, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Michael J. Rosen
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, Ohio
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Oprea V, Toma M, Grad O, Bucuri C, Pavel P, Chiorescu S, Moga D. The outcomes of open anterior component separation versus posterior component separation with transversus abdominis release for complex incisional hernias: a systematic review and meta-analysis. HERNIA : THE JOURNAL OF HERNIAS AND ABDOMINAL WALL SURGERY 2023; 27:503-517. [PMID: 36729336 DOI: 10.1007/s10029-023-02745-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 01/15/2023] [Indexed: 02/03/2023]
Abstract
PURPOSE The main objective was to assess the prevalence of hernia recurrence, wound complications (surgical site infections [SSI], seroma and hematoma) and mortality after anterior component separation (ACS) and posterior component separation via transversus abdominis muscle release (PCSTAR) in patients with complex incisional hernias. The so-called complex IH is a serious medical and societal challenge due to its direct and indirect costs; it is also hampered by the use of different surgical techniques, different type of meshes, and different results heterogeneously reported and interpreted. According to actual data, the best approach seems to be a mesh reinforcement component separation procedure augmented or not with an adjuvant technique (preoperative progressive pneumoperitoneum and/or Botulin toxin type A infiltration). METHODS A systematic search of four databases (MEDLINE, PubMed, Web of Science, and Google Scholars) was conducted to identify studies reporting on outcomes of component separation techniques and which were published before December 2021. A systematic review and a meta-analysis of postoperative outcomes were performed. RESULTS Nineteen studies including 3412 patients (1709 with ACS and 1703 with PCSTAR) were selected. Pooled hernia recurrence rate after a minimum 1-year follow-up was evaluated at 5.15% (odds ratio [OR] 0.68; 95% confidence interval [CI] 0.5-0.9; p = 0.0175). Pooled surgical site infection rate was 10.6% (OR 1.32; 95% CI 1.06-1.65; p = 0.0119). Seroma and hematoma were estimated at 9.75% (OR 1.93; 95% CI 1.52-2.44; p = 0.0001) and 3.83% (OR 1.81; 95% CI 1.26-2.61; p = 0.0012), respectively. ACS was associated with increased wound morbidity, seroma and hematoma. PCSTAR displayed higher recurrence rate (4.27% vs 6.11%). CONCLUSIONS PCSTAR was superior to ACS in terms of wound morbidity, surgical site infections, seroma and hematoma incidence. The procedure should be further evaluated in comparative head-to-head randomized controlled trials.
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Affiliation(s)
- V Oprea
- Clinical Department of Surgery, "Constantin Papilian" Emergency Clinical Military Hospital, No 22 Gral Traian Mosoiu Street, Cluj-Napoca, Cluj County, Romania. .,Second Department of Surgery, Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - M Toma
- Clinical Department of Surgery, "Constantin Papilian" Emergency Clinical Military Hospital, No 22 Gral Traian Mosoiu Street, Cluj-Napoca, Cluj County, Romania
| | - O Grad
- Clinical Department of Surgery, "Constantin Papilian" Emergency Clinical Military Hospital, No 22 Gral Traian Mosoiu Street, Cluj-Napoca, Cluj County, Romania.,Second Department of Surgery, Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - C Bucuri
- Clinical Department of Surgery, "Constantin Papilian" Emergency Clinical Military Hospital, No 22 Gral Traian Mosoiu Street, Cluj-Napoca, Cluj County, Romania.,Second Department of Surgery, Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - P Pavel
- Clinical Department of Surgery, "Constantin Papilian" Emergency Clinical Military Hospital, No 22 Gral Traian Mosoiu Street, Cluj-Napoca, Cluj County, Romania
| | - S Chiorescu
- Second Department of Surgery, Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - D Moga
- Department of Surgery, "Alexandru Augustin" Emergency Military Hospital, Sibiu, Romania.,Medicine and Pharmacy Faculty, "Lucian Blaga" University, Sibiu, Romania
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Morphological alterations of the abdominal wall after open incisional hernia repair with endoscopic anterior and open posterior component separation. Hernia 2022; 27:327-334. [PMID: 36243858 DOI: 10.1007/s10029-022-02694-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 10/09/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE Effects of component separation (CS) on abdominal wall morphology have only been investigated in smaller case series or cadavers. This study aimed to compare abdominal wall alterations following endoscopic anterior CS (EACS) or open transverse abdominis release (TAR). METHODS Computed tomography scans were evaluated in patients who had undergone open incisional hernia repair with EACS or TAR. Abdominal wall circumference, lateral abdominal wall muscle thickness, and displacement were compared with (1) preoperative images after bilateral CS and (2) the undivided side postoperatively after unilateral CS. RESULTS In total, 105 patients were included. Fifty-five (52%) and 15 (14%) underwent bilateral and unilateral EACS, respectively. Five (5%) and 14 (13%) underwent bilateral and unilateral TAR, respectively. Sixteen (15%) underwent unilateral EACS and contralateral TAR. The external oblique and transverse abdominis muscles were significantly laterally displaced with a mean of 2.74 cm (95% CI 2.29-3.19 cm, P < 0.001) and 0.82 cm (0.07-1.57 cm, P = 0.032) after EACS and TAR, respectively. The combined thickness of the lateral muscles was significantly decreased after EACS (mean decrease 10.5% (5.8-15.6%, P < 0.001)) and insignificantly decreased after TAR (mean decrease 2.6% (- 4.8 to 9.5%, P = 0.50)). The abdominal wall circumference was unchanged after bilateral (mean reduction 0.90 cm (- 0.77 to 2.58 cm), P = 0.29) and unilateral CS (mean increase 0.03 cm (- 1.01 to 1.08 cm), P = 0.95). CONCLUSION Postoperative changes in the lateral abdominal wall musculature were different following EACS and open TAR. Either technique seems not to compromise the overall integrity of the lateral abdominal wall.
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Rabie M, Abdelnaby M, Morshed M, Shalaby M. Posterior component separation with transversus abdominis muscle release versus mesh-only repair in the treatment of complex ventral-wall hernia: a randomized controlled trial. BMC Surg 2022; 22:346. [PMID: 36127722 PMCID: PMC9485020 DOI: 10.1186/s12893-022-01794-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 09/08/2022] [Indexed: 12/02/2022] Open
Abstract
Background Complex ventral hernias (VHs) represent a real challenge to both general and plastic surgeons. This study aims to compare Sublay Mesh-Only Repair to Posterior Component Separation “PCS” with Transversus Abdominis Release “TAR” in the treatment of complex ventral-wall hernias (VHs). Methods This a randomized, controlled, intervention, including two parallel groups: A; Sublay Mesh-Only Repair and Group B; “TAR”. Consecutive patients of both genders aged between 18 and 65 years old with complex VHs presented at Mansoura University Hospitals including large-sized abdominal-wall hernia ≥ 10 cm in width, loss of domain ≥ 20%, multiple hernial defects, or recurrent hernias. Immuno-compromised patients, patients with liver impairment, or severe heart failure were considered an exclusion criterion. The primary outcome is the recurrence rate after 12-months following the procedure. Results Fifty-six patients were recruited in this study. There was no significant difference between both groups regarding recurrence. However, there was significant differences between both groups regarding seroma favoring mesh-only repair. Conclusions Although TAR may be associated with longer operative times and more blood losses, these were not found to be statistically significant. Postoperative complication, except for seroma, and recurrence rates were comparable in both groups. Trail registration The study was registered on clicaltrials.gov “NCT04516031”.
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Affiliation(s)
- Mohamed Rabie
- Colorectal Surgery Unit, Department of General Surgery, Mansoura University Hospitals, Mansoura University, 60 ElGomhouria Street, Mansoura, 35516, Dakahliya, Egypt
| | - Mahmoud Abdelnaby
- Colorectal Surgery Unit, Department of General Surgery, Mansoura University Hospitals, Mansoura University, 60 ElGomhouria Street, Mansoura, 35516, Dakahliya, Egypt
| | - Mosaad Morshed
- Colorectal Surgery Unit, Department of General Surgery, Mansoura University Hospitals, Mansoura University, 60 ElGomhouria Street, Mansoura, 35516, Dakahliya, Egypt
| | - Mostafa Shalaby
- Colorectal Surgery Unit, Department of General Surgery, Mansoura University Hospitals, Mansoura University, 60 ElGomhouria Street, Mansoura, 35516, Dakahliya, Egypt.
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Garcia-Urena MÁ, Lopez-Monclus J, de Robin Valle de Lersundi A, Blazquez Hernando LA, Medina Pedrique M, Rial Justo X, Cruz Cidoncha A, Nogueira Sixto M, Munoz-Rodriguez J. Pathways of the preperitoneal plane: from the “fatty triangle” in Rives to the “fatty trident" in extended retromuscular abdominal wall reconstruction. A tribute to Prof. Schumpelick. Hernia 2022; 27:395-407. [PMID: 35426573 DOI: 10.1007/s10029-022-02602-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/08/2022] [Indexed: 12/21/2022]
Abstract
PURPOSE Extended retromuscular dissection performed for abdominal wall reconstruction in complex abdominal wall repair has progressively exposed the anatomy between the peritoneal layer and abdominal wall muscles. This study aimed to assess the morphology and distribution of preperitoneal fat in a cadaveric model and its influence in retromuscular preperitoneal dissections. METHODS Thirty frozen cadaver torsos were dissected by posterior component separation. The shape of the preperitoneal fat was identified, and the dimensions and more significant distances were calculated. RESULTS The results showed that the preperitoneal fat resembles a trident, exists along the midline under the linea alba, and expands in the epigastric area into a rhomboid shape. The fatty triangle was found to be a part of this rhomboid. Caudally, the midline preperitoneal fat widened under the arcuate line to reach the Retzius space. Laterally, the Bogros space communicated the root of the trident with the paracolic gutters, Toldt's fascia, and pararenal fats, forming the lateral prong of the trident. The peritoneum not covered by the preperitoneal fatty trident was easy to break. Three pathways could be tracked following the distribution of this fat that facilitated the dissection of the preperitoneal space to prepare the landing zone of the meshes in hernia repair. CONCLUSION The concept of preperitoneal fatty trident may be of practical assistance to perform various hernia procedures, from the simple ventral hernia repair to the more complex preperitoneal ventral repair or posterior component separation techniques. The consistency of this layer allows us to follow three specific pathways to find our plane between the peritoneum and muscle layers to extend the preperitoneal dissection.
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Affiliation(s)
- M Á Garcia-Urena
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Carretera Pozuelo-Majadahonda km. 1.8, 28223, Pozuelo de Alarcón, Spain
| | - J Lopez-Monclus
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Puerta de Hierro-Majadahonda, Calle Joaquín Rodrigo 2, 28220, Majadahonda, Spain.
| | - A de Robin Valle de Lersundi
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Carretera Pozuelo-Majadahonda km. 1.8, 28223, Pozuelo de Alarcón, Spain
| | - L A Blazquez Hernando
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Ramón y Cajal, M-607, 9,100, 28034, Madrid, Spain
| | - M Medina Pedrique
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Carretera Pozuelo-Majadahonda km. 1.8, 28223, Pozuelo de Alarcón, Spain
| | - X Rial Justo
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Carretera Pozuelo-Majadahonda km. 1.8, 28223, Pozuelo de Alarcón, Spain
| | - A Cruz Cidoncha
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Carretera Pozuelo-Majadahonda km. 1.8, 28223, Pozuelo de Alarcón, Spain
| | - M Nogueira Sixto
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Alvaro Cunqueiro, Estrada de Clara Campoamor 341, 36213, Vigo, Spain
| | - J Munoz-Rodriguez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Puerta de Hierro-Majadahonda, Calle Joaquín Rodrigo 2, 28220, Majadahonda, Spain
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Afaque M, Rizvi A. Comparison between transversus abdominis release and anterior component separation technique in complex ventral hernia. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2020. [DOI: 10.4103/ijawhs.ijawhs_55_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Köhler G. Präoperative Konditionierung und operative Strategien zur Therapie komplexer Bauchwandhernien. Chirurg 2019; 91:134-142. [DOI: 10.1007/s00104-019-01027-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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