Posterior and open anterior components separations: A comparative analysis

Background: Anterior components separation (ACS) creates large lipocutaneous flaps to release the external oblique fascia often leading to major wound complications. Posterior components separation (PCS) involves the release of the posterior rectus sheath and transversus abdominis muscles. We hypothesized that PCS provides effective fascial advancement while reducing wound morbidity during abdominal wall reconstructions. Methods: A retrospective review of consecutive components separation performed by a single surgeon over 5 years. Results: One hundred eleven patients (56 ACS/55 PCS) were analyzed. The mean defect size was 472 and 531 cm ², respectively (P =.28). Five patients in each group required a bridging repair. Wound complications occurred in significantly more ACS than PCS patients (48.2% vs 25.5%, P =.01). The recurrence rate was also higher in the ACS group (14.3% vs 3.6%, P =.09). Conclusions: PCS provides equivalent myofascial advancement with significantly less wound morbidity when compared with ACS. Although further studies are needed, PCS has evolved as an important addition to the armamentarium of surgeons undertaking complex abdominal wall reconstructions.