A New Technique for Minimally Invasive Abdominal Wall Reconstruction of
Complex Incisional Hernias:
Totally Laparoscopic Component
Separation and Incisional Hernia Repair
Ashkan Moazzez, MD
Assistant Professor of Clinical Surgery
Division of General and Laparoscopic Surgery
University of Southern California, Department of Surgery
Los Angeles, CA
Rodney J. Mason. MD, PhD
Associate Professor of Surgery
Keck School of Medicine, University of Southern California
Los Angeles, CA
Namir Katkhouda, MD
Professor and Vice Chairman
Chief, Division of General and Laparoscopic Surgery
Director, Bariatric Surgery Program
University of Southern California
Los Angeles, CA
Since Ramirez et al. presented the first case of component separation for abdominal wall hernias in 1990, it has undergone multiple modifications. This technique, which has been mainly used for large hernias where primary closure of the abdominal wall is not feasible, or for staged management of patients with open abdomens, results in multiple wound complications. In 2007, Rosen et al. reported on the laparoscopic approach to component separation that is associated with less subcutaneous dissection and the consequent advantage of a decreased risk of flap necrosis and wound infection. Here we discuss our totally laparoscopic approach to abdominal wall reconstruction. A minimally invasive abdominal wall reconstruction consists of a bilateral component separation, an intra-abdominal adhesiolysis, primary approximation of rectus muscles, and placement of an intraperitoneal mesh for reinforcing the repair, all performed laparoscopically. Patient-selection criteria, detailed operative technique, tips in preventing and managing the potential pitfalls, and postoperative care are discussed.
