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

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, offering several advantages. The study aims to present a detailed descr...

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Autores: 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
Tipo de recurso: artículo
Fecha de publicación:2024
País:España
Institución:Universidad de Málaga
Repositorio:DDFV. Repositorio Institucional de la Universidad Francisco de Vitoria
Idioma:inglés
OAI Identifier:oai:ddfv.ufv.es:10641/6421
Acceso en línea:https://hdl.handle.net/10641/6421
Access Level:acceso abierto
Palabra clave:Madrid APPROACH
Madrid TAR
Madrid posterior component separation
posterior component separation
posterior rectus sheath release
Surgery
Journal Article
Yes
yes
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spelling The Madrid Posterior Component Separation : An Anatomical Approach for Effective Reconstruction of Complex Midline HerniasDe Luca, MarcelloMedina Pedrique, ManuelMorejon Ruiz, SaraMunoz-Rodriguez, Joaquin M.Robin Valle de Lersundi, AlvaroLopez-Monclus, JavierBlázquez Hernando, Luis AlbertoGarcia-Urena, Miguel AngelMadrid APPROACHMadrid TARMadrid posterior component separationposterior component separationposterior rectus sheath releaseSurgeryJournal ArticleYesyesIntroduction: 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, offering several advantages. The study aims to present a detailed description of this surgical technique and to analyse the outcomes in a large cohort of patients. 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 at three different centres specialising in abdominal wall reconstruction was analysed. All patients underwent the Madrid PCS, and several variables, such as demographics, perioperative details, postoperative complications, and recurrences, were assessed. Results: Between January 2015 and June 2023, a total of 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 (VHWG) classification, 177 (79.4%) patients had grade 2 and 3 hernias. In total, 201 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%. A total of 105 patients (48.4%) 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 by CT scan with an average follow-up of 23.9 months (range 6–74). Conclusion: 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 the anatomy is crucial for optimal outcomes. The Madrid modification contributes to facilitating a complete retromuscular preperitoneal repair without incision of the transversus abdominis. The extensive abdominal wall retromuscular dissection obtained enables the placement of very large meshes with minimal fixation.Facultad de Medicina20242024-01-0120242024-01-01journal articlehttp://purl.org/coar/resource_type/c_6501info:eu-repo/semantics/articleapplication/pdfhttps://hdl.handle.net/10641/6421reponame:DDFV. Repositorio Institucional de la Universidad Francisco de Vitoriainstname:Universidad de MálagaInglésengopen accesshttp://purl.org/coar/access_right/c_abf2http://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:ddfv.ufv.es:10641/64212026-06-11T12:44:57Z
dc.title.none.fl_str_mv The Madrid Posterior Component Separation : An Anatomical Approach for Effective Reconstruction of Complex Midline Hernias
title The Madrid Posterior Component Separation : An Anatomical Approach for Effective Reconstruction of Complex Midline Hernias
spellingShingle The Madrid Posterior Component Separation : An Anatomical Approach for Effective Reconstruction of Complex Midline Hernias
De Luca, Marcello
Madrid APPROACH
Madrid TAR
Madrid posterior component separation
posterior component separation
posterior rectus sheath release
Surgery
Journal Article
Yes
yes
title_short The Madrid Posterior Component Separation : An Anatomical Approach for Effective Reconstruction of Complex Midline Hernias
title_full The Madrid Posterior Component Separation : An Anatomical Approach for Effective Reconstruction of Complex Midline Hernias
title_fullStr The Madrid Posterior Component Separation : An Anatomical Approach for Effective Reconstruction of Complex Midline Hernias
title_full_unstemmed The Madrid Posterior Component Separation : An Anatomical Approach for Effective Reconstruction of Complex Midline Hernias
title_sort The Madrid Posterior Component Separation : An Anatomical Approach for Effective Reconstruction of Complex Midline Hernias
dc.creator.none.fl_str_mv 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
author De Luca, Marcello
author_facet 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
author_role author
author2 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
author2_role author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Facultad de Medicina
dc.subject.none.fl_str_mv Madrid APPROACH
Madrid TAR
Madrid posterior component separation
posterior component separation
posterior rectus sheath release
Surgery
Journal Article
Yes
yes
topic Madrid APPROACH
Madrid TAR
Madrid posterior component separation
posterior component separation
posterior rectus sheath release
Surgery
Journal Article
Yes
yes
description 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, offering several advantages. The study aims to present a detailed description of this surgical technique and to analyse the outcomes in a large cohort of patients. 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 at three different centres specialising in abdominal wall reconstruction was analysed. All patients underwent the Madrid PCS, and several variables, such as demographics, perioperative details, postoperative complications, and recurrences, were assessed. Results: Between January 2015 and June 2023, a total of 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 (VHWG) classification, 177 (79.4%) patients had grade 2 and 3 hernias. In total, 201 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%. A total of 105 patients (48.4%) 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 by CT scan with an average follow-up of 23.9 months (range 6–74). Conclusion: 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 the anatomy is crucial for optimal outcomes. The Madrid modification contributes to facilitating a complete retromuscular preperitoneal repair without incision of the transversus abdominis. The extensive abdominal wall retromuscular dissection obtained enables the placement of very large meshes with minimal fixation.
publishDate 2024
dc.date.none.fl_str_mv 2024
2024-01-01
2024
2024-01-01
dc.type.none.fl_str_mv journal article
http://purl.org/coar/resource_type/c_6501
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://hdl.handle.net/10641/6421
url https://hdl.handle.net/10641/6421
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2

http://creativecommons.org/licenses/by-nc-nd/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2

http://creativecommons.org/licenses/by-nc-nd/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.source.none.fl_str_mv reponame:DDFV. Repositorio Institucional de la Universidad Francisco de Vitoria
instname:Universidad de Málaga
instname_str Universidad de Málaga
reponame_str DDFV. Repositorio Institucional de la Universidad Francisco de Vitoria
collection DDFV. Repositorio Institucional de la Universidad Francisco de Vitoria
repository.name.fl_str_mv
repository.mail.fl_str_mv
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