Scientific paper Laparoscopic versus open-component separation: a comparative analysis in a porcine model Michael J. Rosen, M.D.*, Christina Williams, M.D., Judy Jin, M.D., Michael F. McGee, M.D., Steve Schomisch, B.S., Jeffrey Marks, M.D., Jeffrey Ponsky, M.D. Case Medical Center, University Hospitals of Cleveland, 11100 Euclid Ave., Cleveland, OH 44106, USA Manuscript received December 19, 2006; revised manuscript March 20, 2007 Abstract Background: The ideal surgical treatment for complicated ventral hernias remains elusive. Traditional component separation provides local advancement of native tissue for tension-free closure without prosthetic materials. This technique requires an extensive subcutaneous dissection with division of perforating vessels predisposing to skin-flap necrosis and complicated wound infections. A minimally invasive component separation may decrease wound complication rates; however, the adequacy of the myofascial advancement has not been studied. Methods: Five 25-kg pigs underwent bilateral laparoscopic component separation. A 10-mm incision was made lateral to the rectus abdominus muscle. The external oblique fascia was incised, and a dissecting balloon was inflated between the internal and external oblique muscles. Two additional ports were placed in the intermuscular space. The external oblique was incised from the costal margin to the inguinal ligament. The maximal abdominal wall advancement was recorded. A formal open-component separation was performed and maximal advancement 5 cm superior and 5 cm inferior to the umbilicus was recorded for comparison. Groups were compared using standard statistical analysis. Results: The laparoscopic component separation was completed successfully in all animals, with a mean of 22 min/side. Laparoscopic component separation yielded 3.9 cm (SD 1.1) of fascial advancement above the umbilicus, whereas 4.4 cm (1.2) was obtained after open release (P = .24). Below the umbilicus, laparoscopic release achieved 5.0 cm (1.0) of advancement, whereas 5.8 cm (1.2) was gained after open release (P = .13). Comments: The minimally invasive component separation achieved an average of 86% of the myofascial advancement compared with a formal open release. The laparoscopic approach does not require extensive subcutaneous dissection and might theoretically result in a decreased incidence or decreased complexity of postoperative wound infections or skin-flap necrosis. Based on our preliminary data in this porcine model, further comparative studies of laparoscopic versus open component separation in complex ventral hernia repair is warranted to evaluate postoperative morbidity and long-term hernia recurrence rates. © 2007 Excerpta Medica Inc. All rights reserved. Keywords: Component separation; Laparoscopic; Minimally invasive; Ventral hernia The repair of massive ventral hernias has remained a chal- lenging problem for surgeons. Primary repair is rarely suc- cessful and has associated recurrence rates of 18% to 62% depending on the defect size [1– 4]. The addition of syn- thetic mesh decreases recurrence rates significantly to 2% to 32% [1,3– 6]. However, the use of large sheets of synthetic material for hernia repair often results in a rigid, noncom- pliant, adynamic abdominal wall and is contraindicated in the setting of contamination. Several groups have reported various options using only autologous tissue to deal with these challenging hernias. Ramirez et al described a technique in which the lateral abdominal musculature was partitioned, allowing myofas- cial advancement and extension of the abdominal wall [7]. Several modifications have been described for this tech- nique, but most involve elevation of large subcutaneous * Corresponding author. Tel.: +1-216-844-2763; fax: +1-216-844- 5888. E-mail address: michael.rosen@uhhospitals.org The American Journal of Surgery 194 (2007) 385–389 0002-9610/07/$ – see front matter © 2007 Excerpta Medica Inc. All rights reserved. doi:10.1016/j.amjsurg.2007.03.003