Component separation hernioplasty for huge defect midline incisional hernias, anterior versus posterior with transversus abdominis release: A prospective comparative study

. ABSTRACT Background: Component separation techniques are an integral step in the repair of incisional hernias with huge defects. Anterior component separation (ACS) and posterior component separation (PCS) with transversus abdominis muscle release (TAR) are commonly utilized. Aim: To compare ACS with onlay hernioplasty versus PCS-TAR with retrorectus hernioplasty to treat huge defect incisional hernias. Patients and Methods: This is a prospective comparative study on 35 patients who underwent surgical repair for midline incisional hernias with defects more than 10 cm in width. Patients were randomly allocated into two groups. Group A included patients for ACS with onlay hernioplasty, and group B included patients for PCS-TAR with retrorectus hernioplasty. Surgeries were performed under general anesthesia and patients’ follow-up was done for up to 1 year. Demographic, perioperative, and follow-up data were collected, tabulated, and analyzed by SPSS 26. Results: Group A included 18 patients, and group B included 17 patients. There is no statistically significant difference between the two groups regarding the preoperative variable. PCS-TAR had statistically significant longer operative time, fewer days of suction drainage, lower incidence of Surgical Site Infection (SSI) and seroma, and lower incidence of recurrence. Conclusion: In surgical repair of incisional hernias with huge defects, PCS-TAR had significantly lower wound morbidity and recurrence rates than the ACS.