Ventral Abdominal Hernia Repair: Technique—External Oblique Release

Traditionally, laparotomy closures, large tumor ablations, congenital anomalies, and trauma led to unacceptable rates of ventral hernia and abdominal wall morbidity. Primary fascial coaptation and mesh reinforcement of hernia defects have been demonstrated to significantly reduce both short- and long-term hernia recurrence rates in prospective series. However, wide abdominal defects can present a challenge where fascial approximation is not possible under physiologic tension. In 1990, Ramirez and colleagues introduced the technique of components separation and brought about one of the greater paradigm shifts forward in abdominal wall reconstruction [1]. Components separation exploits the anatomic planes of the abdomen to create musculofascial advancement flaps which assists in fascial closure. Long-term outcomes support components separation for maintaining the strength and integrity of the abdominal wall while preserving innervated muscle function without tension [2–4]. This chapter focuses on planning, techniques, and outcomes of components separation.