Giant ventral hernia treatment with components separation technique and aponeurotic turn over flap

Abstract

Aim: To demonstrate the anatomy and application of the anterior rectus sheet in the repair of giant abdominal wall hernias through a classic component surgery plus a turn over flap.

Materials and Method: Anatomic dissection with vascular and dynamic description of the anterior rectus sheet. Posterior application of the technique in patients with giant abdominal wall hernias. Clinical follow up of recurrence, local and systemic complications.

Results: 8 patients were selected. The average age was 58.6 years old and the abdominal wall defect 19.6 cm wide. The technique could be applied in every patient without inconveniences. Only 1 patient had a complication (dehiscence and partial skin flap necrosis) that was successfully treated with resection and readvancement. No systemic complications nor mortality was described.

Discussion: Giant abdominal wall hernias are a surgical challenge. Great and innovative advances have been made. New biological and synthetic materials have been developed, nevertheless they frequently involve great costs and complications related to them. Also, they do not adapt adequately to the dynamic required for the abdominal wall.

Conclusion: This technical modification is useful, safe and accessible for the patients who present giant wall hernias. The complication rate is low and it’s principally given from problems related to skin flap blood flow.