Component separation

• International Consensus Definition 2020:
  • “A ventral hernia large enough such that simple reduction in its contents and primary fascial closure either cannot be achieved without additional reconstructive techniques OR cannot be achieved without significant risk of complications due to the raised intra-abdominal pressure”

If ratio >25% then LOD and need for techniques such as botox or progressive pneumoperitoneum

Component seperation

• Options
  • Non-surgical
    • Using pre-operative Botox
  • Surgical
    • Posterior rectus release (Rives Stoppa)
    • External oblique release
    • Transverse Abdominis release

Posterior rectus release (Rives Stoppa)

• First step in the bottom two
• Create a retro rectus space
• If there is enough movement then can close posterior sheath, place mesh and close anterior sheath

External oblique release

• Rectrorectus mobilisation and then anterior release of external oblique

Transverse Abdominis release

• Continue from rectorectus plane and divide transverse abdominus muscle
• To create a larger plane for mesh placement and also more medialiastion of sheath