This document details the case of a 28-year-old male with a large abdominal wall hernia undergoing a component separation technique for repair. The procedure involves extensive dissection and the placement of a polypropylene mesh to ensure a tension-free closure. The postoperative recovery was successful, with the patient discharged on the 7th postoperative day.

1. Component separation technique for a very
large abdominal wall hernia
• 28 years male.
• Abdominal distention since 1 month.
• P/A- Large Ventral Hernia with widely gapping
recti muscles, thinning of overlying skin, gross
abdominal distention.
• Past history: Ileostomy and Colostomy for
megacolon with Crohn’s Colitis followed by closure
of stoma.

2. Planned for Incisional hernia repair (component
separation technique)
with mesh

3. Step 1. Incision planning
Skin incision is planned considering the size of the defect and
the laxity of the overlying skin.

4. Step 2. Lateral dissection
• Extensive lateral dissection is done on both sides beyond
the rectus muscle to expose the external oblique
aponeurosis.

5. Step 3. Bilateral Lateral Incision on external
oblique aponeurosis
Long vertical incisions are
placed on both sides
starting from costal
margin up to the pelvic
bone inferiorly on both
sides.

6. Step 4. Dissection between external and internal
oblique muscles
• Extensive blunt dissection
done in between the two
muscles in an avascular plane
to separate the components
and gain 7-10 cm medial shift
of the anterior component.
• If necessary posterior incision
on posterior rectus sheath can
also be placed to further gain
a shift of 3-4 cm.

7. Step 5. Midline mass closure with interrupted
sutures
Midline closure was
done without tension
with interrupted non
absorbable no 1
sutures

8. Step 6. Overlay repair with Polypropelene mesh
A large piece of
polypropylene mesh (30
* 15 cm) is placed over
the repair to have an
adequate cover and
overlap all around the
defect and fixed to
parities with sutures.

9. Step 7 Closure with negative suction drains
Post-operative Course
• Liquids were started on 2nd POD.
• Semisolid diet on 3rd POD and normal diet on 4th POD.
• Drains removed on 7th POD.
• Discharged on 7th POD.

10. Conclusion
• Component separation technique is an excellent technique
for large ventral central defects which can allow a medial
shift of approx. 10 cm on each side to cover the defect
without tension.
• An overlay mesh repair is performed to reinforce the mass
closure
• This technique can prevent intra-abdominal compartment
syndrome and postoperative pain and can allow tension
free repair of large hernias