Madrid Posterior Component Separation
摘要
Posterior component separation techniques have become one of the most effective methods for complex abdominal wall reconstruction. Based on our experience and cadaveric studies, we propose a modification of the transversus abdominis release (TAR) technique. This modification focuses on the myofascial boundary of the transversus abdominis muscle, the distribution of preperitoneal fat beneath the abdominal wall muscles, and the preservation of the posterior rectus sheath insertion at the costal cartilage. Essentially, this modification involves accessing the lateral preperitoneal plane beneath the diaphragm and transversus abdominis muscle by releasing the lateral border of the posterior rectus sheath without dividing the transversus abdominis muscle fibers. The lateral release is facilitated by an extended preperitoneal dissection, which can be initiated in the epigastric area and the Bogros spaces. We typically achieve a wide overlap from the diaphragm to Cooper’s ligaments and from one quadratus lumborum-psoas complex to the contralateral side. A large synthetic mesh (50 x 50 cm), placed in a diamond configuration, wraps the visceral sac, extending over an absorbable mesh and secured solely to Cooper’s ligaments. The lateral border of the posterior rectus sheath is reimplanted onto the synthetic mesh with running sutures to restore the transversus abdominis muscle insertion.