Is release of the posterior lamella enough? A cadaveric exploration of posterior component separation techniques

N. Moores, H. Conway, D. Donato, B. Gociman, C. J. Pannucci, J. Agarwal

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)533-536
Number of pages4
JournalAmerican Journal of Surgery
Volume218
Issue number3
DOIs
StatePublished - Sep 2019
Externally publishedYes

Keywords

  • Abdominal wall reconstruction
  • Component separation
  • External oblique release
  • Hernia
  • Posterior lamella release
  • TAR
  • Transversus abdominis release
  • Transversus abdominus release

ASJC Scopus subject areas

  • Surgery

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