Editing Component separation (section)

== '''Posterior component separation''' ==
introduced 2012

** Posterior lamellar of IO is incised to achieve myofascial advancement, while transversus abdominis is incised and released from the peritoneum in the upper third of the abdomen
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** Clear abdo wall of adhesions - can't do the dissection safely with bowel adherent to anterior abdo wall
** Use a towel to protect bowel
** Incise peritoneum just lateral to linea alba until rectus abdominis muscle is seen

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** Posterior rectus sheath dissected free of rectus muscle until linea semilunaris is exposed (look out for neurovascular bundle just medial to LS in rectus muscle)

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** Posterior lamellar of IO is incised just medial to the neurovascular bundles, which exposes the transversus abdominis muscle in the upper third of the abdomen

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** Right angle clamp used to guide transection of the TA muscle, which exposes peritoneum (very thin layer underneath, and easy to break)

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** Once posterior rectus sheath is incised completely along its length, the TA muscle is separated from the peritoneum using appropriate traction-counter traction. Don't make holes in peritoneum - if it happens, work lateral and get behind the defect before it gets bigger. Free peritoneum out to psoas muscle if necessary.

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** In pelvis, Cooper's ligaments are exposed bilaterally, and the bladder is taken down. At the xiphoid process, the medial edge of the posterior rectus sheath is incised in a cephalad fashion towards the diaphragm.
** Posterior rectus sheath is reapproximated using 2-0 absorbable suture
** Mesh inserted into preperitoneal pocket and fixed with transfascial sutures
** Drains placed over the mesh and below the fascial closure
** Linea alba reapproximated and skin closed