AUTHOR=De Luca Marcello , Medina Pedrique Manuel , Morejon Ruiz Sara , Munoz-Rodriguez Joaquin M. , Robin Valle de Lersundi Alvaro , Lopez-Monclus Javier , Blázquez Hernando Luis Alberto , Garcia-Urena Miguel Angel 

TITLE=The Madrid Posterior Component Separation: An Anatomical Approach for Effective Reconstruction of Complex Midline Hernias

JOURNAL=Journal of Abdominal Wall Surgery

VOLUME=Volume 3 - 2024

YEAR=2024

URL=https://www.frontierspartnerships.org/journals/journal-of-abdominal-wall-surgery/articles/10.3389/jaws.2024.12928

DOI=10.3389/jaws.2024.12928

ISSN=2813-2092

ABSTRACT=Introduction. In recent years, Posterior Component Separation (PCS) with the Madrid modification (Madrid PCS) has emerged as a surgical technique. This modification is believed to enhance the dissection of anatomical structures, providing several advantages. The study aims to present a detailed description of the surgical technique and analyze the outcomes in a large patient cohort.
Materials and Methods. This study included all patients who underwent the repair of midline incisional hernias, with or without other abdominal wall defects. Data from patients across three different centers specializing in abdominal wall reconstruction were analyzed. All patients underwent Madrid PCS, and various variables, including demographics, perioperative details, postoperative complications, and recurrences, were assessed.
Results. Between January 2015 and June 2023, 223 patients underwent the Madrid PCS. The mean age was 63.4 years, with a mean BMI of 33.3 kg/m2 (range 23-40). According to the EHS classification, 139 patients had a midline incisional hernia, and 84 had a midline incisional hernia with a concomitant lateral incisional hernia. According to the Ventral Hernia Working Group classification (VHWG), 177 (79.4%) patients were of grade 2 and 3. Two hundred and one patients (90.1%) were ASA II and III. The Carolinas Equation for Determining Associated Risks (CeDAR) was calculated preoperatively, resulting in 150 (67.3%) patients with a score between 30 and 60%. One hundred five (48.4%) patients had previously undergone abdominal wall repair surgery. There were 93 (41.7%) surgical site occurrences (SSO), 36 (16.1%) surgical site infections (SSI), including 23 (10.3%) superficial and 7 (3.1%) deep infections, and 6 (2.7%) organ/space infections. Four (1.9%) recurrences were assessed with a CT scan with an average follow-up of 23.9 months (range 6-74).
Conclusions. The Madrid PCS appears to be safe and effective, yielding excellent long-term results despite the complexity of abdominal wall defects. A profound understanding of anatomy is crucial for optimal outcomes. The Madrid modification contributes to facilitating a complete retromuscular preperitoneal repair without incising the transversus abdominis. The extensive abdominal wall retromuscular dissection obtained enables the placement of very large meshes with minimal fixation.