eCST: The endoscopic-assisted component separation technique for (complex) abdominal wall reconstruction

Introduction: In 1990, Ramirez introduced his component separation technique (CST) based on enlargement of the abdominal wall for reconstruction of large abdominal wall defects. CST is prone to postoperative wound complications which lead to modification of the technique to an endoscopic assisted CST. The details of the technique are described in detail with illustrations and report the results of a 36 patient cohort. Materials and Methods: Between 2014 and 2018, patients with midline hernias without previous subcutaneous dissection underwent endoscopic-assisted anterior components separation technique (eCST) with retro-rectus mesh enforcement in an expert center for abdominal wall reconstructions. Prospective data were gathered during inpatient care and at least 2 years of follow-up. Results: A total of 36 eCST procedures were performed. Eight patients (22%) had postoperative seroma in the dissection plan between external and internal rectus muscle, 3 (8%) had a hematoma, 1 (3%) had wound dehiscence. Clinical relevant SSEs were present in 4 patients (11%) and consisted of 3 (8%) puncture in seroma, 1 (3%) patient needed a blood transfusion due to large hematoma. One patient was re-operated within 90 days; however, this was the placement of a surgical tracheostomy. Three patients had a recurrence in a mean follow-up length of 24 months. Conclusion: eCST can be useful in selected patients.