Comparative Study between Posterior Component Separation with Transversus Abdominis Release and Anterior Component Separation in Management of Large Ventral Abdominal Hernia

Abstract Background: Primary closure of ventral abdominal hernia (VAH) with a large efect size is considered a major problem for surgeons. Anterior component separation (ACS) is a good technique for repairing but incidence of wound seroma is relatively high but, posterior component separation with transversus abdominis release (PCS-TAR) had less incidence of wound complication. Aim of Study: This work aims to compare between poste-rior component separation with transversus abdominis release and anterior component separation in management of large ventral abdominal hernia, as regard post-operative outcome and complications. Patients and Methods: This is prospective comparative research done at the hospitals of Ain Shams University from July 2019 to July 2021 on 40 patients diagnosed as having large ventral abdominal hernia with surface area ranged from 100cm2 to 300cm2. Two equal groups of subjects: A: Repair with ACS and B: Repair with PCS-TAR. Results: No notable differences were found to exist in the two groups in terms ofoperative data, the mean operative time for ACS was 196.25 minutes versus 213.25 minutes for PCS-TAR. The mean blood loss in ACS was 472.5ml versus 455ml in group PCS-TAR. There was no failure or injury in both groups. As regarding the mean hospital stay for ACS was 5.8 days versus 5.6 days for PCS-TAR with non-significant difference. PCS-TAR showed significant shorter time for drain removal than ACS, the mean time was 14.15 days for ACS, and was 9.95 days for PCS-TAR. Regarding post-operative complications, there was wound infection in 15% of cases of ACSversus 10% of cases of PCS-TAR, with non-significant difference. Patients developed seroma were signif-icantly less in PCS-TAR than in ACS [5% of cases of PCS-TAR versus 35% of cases of ACS]. Both groups did not show a significant difference in recurrence within 12 months of follow-up. We had no post-operative bleeding in both groups. Conclusion: PCS-TAR is an effective technique for re-pairing large ventral hernia with fewer postoperative wound complications compared to ACS. We recommend putting this technique to be the first choice in repairing of large ventral hernia.