Hernias comprise a growing problem in surgical science. The most recent classification scheme for hernias emphasizes on the size of defect as well as on whether it is an incisional hernia. The latter group includes complex hernias, namely hernias that can not be managed with simple surgical techniques. This can be accomplished with retromuscular repairs or the more complex anterior and posterior component separation techniques. An anatomic repair is usually reinforced with interposition of mesh. Newest techniques, such as the use of botulinum toxin to induce temporary paralysis of the lateral abdominal wall musculature, referred to as chemical component separation, now present new tools in the restoration of anatomy-based repairs. The chapter entitled “Anatomical and surgical principles of ventral hernia repairs” aims to describe the anatomical and surgical principles of current practice regarding the repair of ventral -primary and incisional-hernias.
Part of the book: Hernia Surgery
Abdominal wall hernias represent a clinical spectrum ranging from a small defect in the abdominal wall causing minimal interruption to patients up to massive defects with severe impairment in abdominal wall function and physiology. Principles of successful hernia repair rely on re-approximation of fascial defect edges to achieve primary closure in a tension free manner and subsequent reenforcement of the repair with a mesh. In the case of large defects, especially in the incisional hernia scenario, advanced fascial release techniques with separation of components is often required to recreate normal anatomy. Relevant techniques are anterior component separation with or without sparing of periumbilical vascular perforators and posterior component separation with transverse abdominis release, representing an expansion of the retrorectus Rives-Stoppa repair. With regards to surgical planning, preoperative imaging, standardization of techniques according to patient and hernia defect characteristics as well as prehabilitation of the abdominal wall with botulinum toxin (“chemical component separation”) represent significant weapons in the armamentarium of the complex abdominal wall reconstruction surgeon. The scope of this chapter is to attempt to unify pathophysiologic concepts of hernias with anatomic-based advanced repairs.
Part of the book: Hernia Updates and Approaches