Comparative study between posterior component separation with transversus abdominis release and anterior component separation in management of large ventral abdominal hernia

Background Component separation is the ideal management for large ventral abdominal hernia. There are different techniques of component separation used for repair. The most popular of them are posterior component separation with transversus abdominis release and anterior component separation (ACS). In this study, we aimed to compare between both techniques in the management of large midline ventral abdominal hernia. Patients and methods This is a prospective comparative study on 40 patients diagnosed as having large midline ventral abdominal hernia with a surface area defect between 300 and 600 cm2, with a defect width more than 10 cm, presented to Ain Shams University hospitals. Patients were divided into two groups, with 20 patients in each. Group A underwent hernial repair by ACS, and group B underwent hernial repair by using posterior component separation with transversus abdominis muscle release (PCS-TAR). Results We had no statistically significant difference in the preoperative demographic data between both groups. Regarding the operative data, the mean operative time in the PCS-TAR group was significantly higher than the ACS group (267.5 vs. 254.25 min, respectively). There was a nonsignificant difference in the blood loss between both groups. Regarding the postoperative data, the mean time of drain removal was significantly higher in the ACS group than the PCS-TAR group (14.9 vs. 13.6 days, respectively). The incidence of wound seroma and infection was significantly higher in the ACS group than the PCS-TAR group. After 12 months of follow-up, we had only one (5%) case with recurrence in the PCS-TAR group versus six (30%) patients in the ACS group, and this difference was statistically significant. Conclusion Posterior component separation with TAR is preferred over ACS in terms of wound complications and recurrence in large midline ventral hernia with defect surface area between 300 and 600 cm2 but with longer operative time.