Background: Large incisional hernias require medialization of the rectus abdominis muscles to facilitate tension-free closure. Medialization may be achieved by Rives-Stoppa, anterior component separation, or posterior component separation. This study aims to compare medialization achieved by these techniques in postmortem human specimens. Methods: First, the Rives-Stoppa procedure was performed. Subsequently, anterior and posterior component separation were performed on one side in each specimen, with each specimen functioning as its own control. Medialization was measured at three levels of the linea alba with three 1-kg weights. Both medialization obtained in addition to initial medialization after opening the linea alba and total medialization were measured. Results are presented as median and interquartile range. Results: A total of 13 postmortem human specimens were included (Rives-Stoppa n = 13, component separation n = 10). Additional medialization after Rives-Stoppa was 1.2 cm (IQR: 0.3–2.2) for the anterior rectus sheath and 2.2 cm (IQR: 1.6–3.0) for the posterior rectus sheath (total medialization: 3.9 and 4.5 cm). For the anterior rectus sheath, additional medialization was 2.6 cm (IQR: 1.2–3.6) after anterior component separation and 1.9 cm (IQR: 0.4–3.4) after posterior component separation (P = .125, total medialization: 6.5 and 5.7 cm). For the posterior rectus sheath, additional medialization was 3.0 cm (IQR: 2.2–3.7) after anterior component separation and 5.2 cm (IQR: 4.2–5.9) after posterior component separation (P < .001, total medialization: 5.8 and 9.4 cm). Conclusion: Posterior component separation yielded significantly more medialization of the posterior rectus sheath compared with Rives-Stoppa and anterior component separation. Anterior component separation may provide marginally more medialization of the anterior rectus sheath.

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Journal Surgery
Sneiders, D., Yurtkap, Y., Kroese, L.F., Jeekel, J, Muysoms, F.E, Kleinrensink, G.J, & Lange, J.F. (2019). Anatomical study comparing medialization after Rives-Stoppa, anterior component separation, and posterior component separation. Surgery, 165(5), 996–1002. doi:10.1016/j.surg.2018.11.013