Outcomes of anterior component separation versus posterior component separation with transversus abdominis muscle release for large incisional hernias: a systematic review and meta-analysis
MOHAMEDAHMED, Ali Yasen Y. ISSA, Mohamed Talaat Mohamed Zaman, Shafquat Mohammed , Safeya Mohamedahmed, Marwa Yassin Hamid, Mohammed Muhammed, A K Ali odogwu, stephen Kabir, Syed Adnan
MOHAMEDAHMED, Ali Yasen Y.
ISSA, Mohamed Talaat Mohamed
Zaman, Shafquat
Mohammed , Safeya
Mohamedahmed, Marwa Yassin
Hamid, Mohammed
Muhammed, A K Ali
odogwu, stephen
Kabir, Syed Adnan
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Affiliation
University Hospitals of Coventry and Warwick, Coventry; Walsall Healthcare NHS Trust; University of Birmingham; University Hospitals of Derby and Burton NHS Foundation Trust; Ibrahim Malik Teaching Hospital; Atbara Teaching Hospital; St Mark's Hospital
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Publication date
2025-10-09
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Abstract
BACKGROUND: Large incisional hernias (IHs), especially with loss of domain, pose significant challenges for repair. Component separation, as a method of repair, allows for adequate coverage of large hernial defects. We compared outcomes of anterior component separation (ACS) versus posterior component separation with transversus abdominis muscle release (PCSTAR) in the repair of large IHs.
METHODS: A systematic search of various electronic databases was conducted to identify studies (published between January 1990 - June 2025) comparing ACS and PCSTAR performed for IH repair. The included studies were assessed for risk of bias (RoB) using validated tools appropriate to study design (Cochrane RoB for randomised controlled trials (RCTs), MINORS for non-randomised studies). Our evaluated outcome measures included overall wound complications, surgical site infections (SSI), hematoma and seroma formation, total operative time, length of hospital stay (LOS), and recurrence rate. Data were analysed using RevMan 5.3, employing a random-effects model.
RESULTS: A total of eight studies (three RCTs and five observational studies) with 2293 patients (1573 with ACS and 720 with PCSTAR) were included. The PCSTAR group demonstrated a lower rate of overall wound complications (odds ratio [OR] 2.58, P = 0.004) and SSIs (OR 1.72, P = 0.05) compared with the ACS group. No significant differences were observed for hematoma (OR 0.87, P = 0.51) or seroma formation (OR 1.77, P = 0.11), recurrence rate (OR 1.81, P = 0.31), operative time (mean difference [MD] -6.57, P = 0.77), or LOS (MD -0.67, P = 0.16) between the two groups. Overall, RCTs demonstrated a low risk of bias in most domains, whilst non-randomised studies showed moderate methodological quality.
CONCLUSION: Both component separation techniques demonstrated comparable outcomes and efficacy in the repair of large incisional ventral hernias (IVHs). However, PCSTAR seems to be associated with reduced overall wound complications and SSI rates. A small number of included RCTs mandate that further adequately powered, well-designed RCTs are required to validate these findings.
Citation
Mohamedahmed AY, Issa MT, Zaman S, Mohammed S, Mohamedahmed MY, Hamid M, Muhammed AKA, Odogwu S, Kabir SA. Outcomes of anterior component separation versus posterior component separation with transversus abdominis muscle release for large incisional hernias: a systematic review and meta-analysis. Hernia. 2025 Oct 9;29(1):289. doi: 10.1007/s10029-025-03487-5. PMID: 41065899; PMCID: PMC12511176.
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Article