Perforator Preserving Anterior Component Separation Technique Combined with Peritoneal Flap Hernioplasty in Patients of Complex Ventral Hernia

Complex ventral hernia which is large with wide defect requires multiple strategies to expand the abdominal wall. We have combined open perforator preserving anterior component separation technique with peritoneal flap hernioplasty in patients with large incisional hernias. We have described the indication, technique, and intraoperative and postoperative outcomes of this combined technique. To the best of our knowledge, this is the first report of this combined procedure. The surgeries were performed between May 2022 and January 2024. The patient had large midline hernias with more than 10-cm defect width. The patients were evaluated for operative time, postoperative pain, surgical site infection, seroma, hematoma, skin necrosis, recurrence, pseudo-recurrence (bulge), 90-day readmission, chronic pain, and Clavien-Dindo score. We operated six patients with this technique. All were women, and the mean age was 35 years (range 15–50). The mean BMI was 24 kg/mt² (range 21–28). All were midline incisional hernias, and one had twice recurrence. The mean defect width was 14 cm (range 11–18), and the mean operative time was 147 min (range 130–160). There was one superficial surgical site infection (Clavien-Dindo 3a). In the postoperative period, none of the patients had seroma, hematoma, skin necrosis, recurrence, pseudo-recurrence, or chronic pain. The patients were followed for 8 months mean (range 3–22). In patients with large midline ventral hernia, perforator preserving anterior component separation technique can be combined with peritoneal flap hernioplasty to achieve tension-free fascial closure. However, more studies with large sample size and long follow-up period are needed on this.