Evidence map›Paper›PMID 31399946›Full record

ArticleSurgical endoscopy2020

Evaluation of anterior versus posterior component separation for hernia repair in a cadaveric model.

Arnab Majumder, Luis A Martin-Del-Campo, Heidi J Miller, Dina Podolsky, Hooman Soltanian, Yuri W Novitsky

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Article in Surgical endoscopy, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.

0numbers the graph read from it
0cells of the map it votes in
19citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

19 citing papers in PubMed.

  1. Trial
  2. Follow-up of complex hernia repair with intraoperative fascial traction.Hernia : the journal of hernias and abdominal wall surgery · 2025
    Article
  3. Review
  4. Article
  5. Article
  6. Article
  7. Intra-abdominal hypertension and compartment syndrome after complex hernia repair.Hernia : the journal of hernias and abdominal wall surgery · 2024
    Review
  8. Article
  9. Review
  10. Article
  11. Article
  12. Article
  13. State-of-the-art abdominal wall reconstruction and closure.Langenbeck's archives of surgery · 2023
    Article
  14. Article
  15. Article
  16. Article
  17. Article
  18. Article
  19. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Arnab MajumderDepartment of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Luis A Martin-Del-CampoDepartment of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Heidi J MillerDepartment of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Dina PodolskyColumbia Hernia Center, Department of Surgery, Columbia University Medical Center, Columbia University, 161 Fort Washington Ave, New York, NY, 10032, USA.
Hooman SoltanianDepartment of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Yuri W NovitskyDepartment of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. yn2339@cumc.columbia.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundComponent separation remains an integral step during ventral hernia repair. Although a multitude of techniques are described, anterior component separation (ACS) via external oblique release (EOR) and posterior component separation (PCS) via transversus abdominis muscle release (TAR) are commonly utilized. The extent of myofascial medialization after ACS or PCS has not been well elucidated. We conducted a comparative analysis of ACS versus PCS in an established cadaveric model.

methodsFifteen cadavers underwent both ACS via EOR and PCS via TAR. Following midline laparotomy (MLL), baseline myofascial elasticity was measured. Steps for ACS included creation of subcutaneous flaps (SQF), external oblique release (EOR), and retrorectus dissection (RRD). For PCS, steps included retrorectus dissection (RRD), transversus abdominis muscle division (TAD), and retromuscular dissection (RMD). Maximal advancement of anterior rectus fascia (ARF) was measured following application of tension to the fascia as a whole, and separately at upper, middle, and lower segments. Statistical analysis was performed with Mann-Whitney U test. Values are represented as average myofascial medialization in centimeters.

resultsFollowing MLL an average of 5.0 ± 0.9 cm (range 3.4-6.0 cm) of baseline medialization was obtained. Complete ACS provided 8.8 ± 1.2 cm (range 6.3-10.7 cm) of ARF advancement compared to 10.2 ± 1.7 cm (range 7.6-12.7 cm) with PCS, p = 0.046. In the upper and mid-abdomen, we noted increased ARF advancement with PCS versus ACS (8.1 ± 1.4 cm vs. 6.7 ± 1.2 cm and 11.4 ± 1.5 vs. 9.6 ± 1.4 cm, respectively, p = 0.01). Similar levels of ARF advancement were observed in the lower abdomen, 9.1 ± 1.7 cm versus 8.7 ± 1.8 cm, p = 0.535.

conclusionsComponent separation via both anterior and posterior approaches provide substantial myofascial advancement. In our model, we noted statistically greater anterior fascial medialization after PCS versus ACS as a whole, and especially in the upper and mid-abdomen. We advocate PCS as a reliable and possibly superior alternative for linea alba restoration for reconstructive repairs, especially for large defects in the upper and mid-abdomen.

Indexed as

CadaverFemaleHernia, VentralHerniorrhaphyHumansMaleComponent separationExternal oblique releaseMyofascial advancementTransversus abdominis releaseVentral hernia repair

Identifiers

PMID31399946

What OpenQuestion holds

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Read underepoch 390

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.