Component separation technique

Component separation involves the division of portions of the anterior and posterior rectus sheaths to gain adequate fascial coverage of the defect (A). The hernia sac is dissected from the surrounding tissues, and the hernia contents are reduced into the abdomen (B). The abdominal wall is then undermined, the external oblique is exposed, and the oblique fascia is divided, allowing the external oblique muscle to separate from the underlying internal oblique (B). The posterior rectus sheath can also be incised (C). These maneuvers add lateral length to the abdominal wall and will allow the fascial edges to be brought together without tension (D). Component separation allows advancement of the rectus abdominis muscle by as much as 20 cm. A larger defect can be bridged using this technique and mesh (E).