Endoscopic component separation

Published on 09/04/2015 by admin

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Last modified 09/04/2015

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CHAPTER 17 Endoscopic component separation

Step 2. Preoperative considerations

Patient preparation

Endoscopic component separation (ECS) is most useful for patients with midline defects of more than 5 to 8 cm in width as measured between the medial borders of the rectus muscle bellies (Figure 17-2).

Symptoms associated with large defects that can be improved with component separation include a large abdominal wall deformity, difficulty leaning forward, difficulty fitting clothes, and discomfort related to pressure pushing the skin outward. Less clearly associated symptoms include inability to carry out activities of daily living or work, skin ulceration, and difficulties with an ostomy appliance if present.

Component separation can be incorporated with open, laparoscopic, or laparoscopic-assisted hernia repair. Patient selection for each approach is based on the specific clinical characteristics, most of which can be determined preoperatively with a physical examination and computed tomography (CT). Open and laparoscopic-assisted approaches have the advantage of suturing the midline together with more accuracy and strength, compared to laparoscopic techniques.

Preoperative CT is useful for operative planning if considering a laparoscopic or laparoscopic-assisted approach. The exact dimensions of the defect can be ascertained, along with the calculated location of the lateral border of the rectus abdominis muscle. The latter measurement is particularly important if performing ECS as the initial portion of the operation (Figure 17-3).

Prior abdominal access in the vicinity of the rectus and oblique muscles pose potential difficulty because of adhesions between fascial planes. Examples include open appendectomy or laterally based ostomy sites.