SynthesisHernia : the journal of hernias and abdominal wall surgery2025
Outcomes of anterior component separation versus posterior component separation with transversus abdominis muscle release for large incisional hernias: a systematic review and meta-analysis.
Synthesis in Hernia : the journal of hernias and abdominal wall surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Botulinum toxin, progressive pneumoperitoneum and RTL closure for ventral hernias secondary to giant omphalocele in children: a 10-patient series.Hernia : the journal of hernias and abdominal wall surgery · 2026Article
- Letter to the Editor: Experimental Characterisation of the Anisotropic Behaviour of the Different Tissue Layers of Human Abdominal Wall.Annals of biomedical engineering · 2026Article
- Incisional hernia repair using component separation with perforator preservation and onlay mesh: A pilot study.Hernia : the journal of hernias and abdominal wall surgery · 2026Article
- Less pain and foreign body sensation after incisional hernia repair with partially absorbable mesh than with non-absorbable mesh: a retrospective sequential cohort study.Hernia : the journal of hernias and abdominal wall surgery · 2026Article
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundLarge 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.
methodsA 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.
resultsA 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.
conclusionBoth 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.
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