TY - JOUR
T1 - Is release of the posterior lamella enough? A cadaveric exploration of posterior component separation techniques
AU - Moores, N.
AU - Conway, H.
AU - Donato, D.
AU - Gociman, B.
AU - Pannucci, C. J.
AU - Agarwal, J.
N1 - Publisher Copyright:
© 2018
PY - 2019/9
Y1 - 2019/9
N2 - Background: As posterior component separation techniques continue to gain popularity there is uncertainty regarding the degree of fascial advancement afforded by the various techniques. Our study seeks to compare the degree anterior rectus sheath translation seen in full transversus abdominus release compared to simple release of the posterior lamella of the rectus sheath. Methods: Ten hemi-abdomens in five fresh cadavers were dissected. One hemi-abdomen underwent external oblique release. The contralateral hemi-abdomen underwent retrorectus dissection and initial release of the internal lamella of the internal oblique, followed by full transversus abdominus release. A 4 kg weight was suspended from the fascia and excursion was measured after 1) external oblique separation, 2) posterior lamella of the internal oblique separation, and 3) transversus abdominis separation. Results: Average unilateral hemifascial translation after release of the external oblique provided an average unilateral hemi-fascial translation of 3.38 cm (+/- 0.69). Release of the posterior lamella of the internal oblique provided 3.98 cm (+/- 0.94). After transversus release the average translation increased to 4.31 cm (+/- 0.89). Conclusions: In this cadaveric study, the majority (92%) of fascial advancement afforded by posterior component separation was achieved by an intermediate step in the transversus abdominus release operation: division of the posterior lamella of the internal oblique.
AB - Background: As posterior component separation techniques continue to gain popularity there is uncertainty regarding the degree of fascial advancement afforded by the various techniques. Our study seeks to compare the degree anterior rectus sheath translation seen in full transversus abdominus release compared to simple release of the posterior lamella of the rectus sheath. Methods: Ten hemi-abdomens in five fresh cadavers were dissected. One hemi-abdomen underwent external oblique release. The contralateral hemi-abdomen underwent retrorectus dissection and initial release of the internal lamella of the internal oblique, followed by full transversus abdominus release. A 4 kg weight was suspended from the fascia and excursion was measured after 1) external oblique separation, 2) posterior lamella of the internal oblique separation, and 3) transversus abdominis separation. Results: Average unilateral hemifascial translation after release of the external oblique provided an average unilateral hemi-fascial translation of 3.38 cm (+/- 0.69). Release of the posterior lamella of the internal oblique provided 3.98 cm (+/- 0.94). After transversus release the average translation increased to 4.31 cm (+/- 0.89). Conclusions: In this cadaveric study, the majority (92%) of fascial advancement afforded by posterior component separation was achieved by an intermediate step in the transversus abdominus release operation: division of the posterior lamella of the internal oblique.
KW - Abdominal wall reconstruction
KW - Component separation
KW - External oblique release
KW - Hernia
KW - Posterior lamella release
KW - TAR
KW - Transversus abdominis release
KW - Transversus abdominus release
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U2 - 10.1016/j.amjsurg.2018.12.011
DO - 10.1016/j.amjsurg.2018.12.011
M3 - Article
C2 - 30591182
AN - SCOPUS:85058976604
SN - 0002-9610
VL - 218
SP - 533
EP - 536
JO - American Journal of Surgery
JF - American Journal of Surgery
IS - 3
ER -