Role of Multi-detector Computed Tomography (MDCT) based component separation index (CSI) in management of large ventral hernias by Component separation technique

Deborshi Sharma, Prof, Vinay Upadhyay, Dr, Romesh Lal, Prof, Dr. Lady Hardinge and Dr RML Hospital

Introduction: Laparoscopic Ventral Hernia Repair has lower recurrences when defect is closed and overlapped with mesh. In large complex ventral hernias, tension free closure of defect is not possible. Component separation (CS) can facilitate tension free closure of defect. Pre-operative prediction, regarding need of CS for tension free closure of defect is the present need.

Aim: Assess ability and efficiency of MDCT based component separation index (CSI) in deciding necessity for component separation during repair of large ventral hernias.

Materials and Methods: Thirty patients with clinical diagnosis of ventral hernia underwent MDCT and CSI was calculated (CSI= Angle of diastases/360). Group I (First 15 patients) – Open Group. Per-operative assessment was done for tension free closure of defect and CS performed if required. CSI value above which complete defect closure necessitated component separation was taken as the CSI reference point. Group II (Next 15 patients) – Laparoscopic Group. Patients with CSI at or below reference point of group I, directly underwent laparoscopic defect closure with IPOM. The other cases with CSI value above the reference point of group I, first had endoscopic assisted laparoscopic component separation (LCS) before entry into peritoneal cavity for defect closure and IPOM.

Results: In Group I, defects with CSI above 0.067 required CS for closure, while in Group II, CSI above 0.044 could only be closed completely without LCS. Further in open approach, defect with CSI > 0.25 and in laparoscopy group CSI > 0.125, defect closure was not possible even after CS or LCS respectively.

Conclusion: CSI is a more comprehensive parameter for evaluation of ventral hernia than conventional two-dimensional parameters of defect and can predict the need of component separation prior to tension free closure of defect in both laparoscopic and open approach. In Laparoscopy complete defect closure is possible with lower CSI values compared to open approach.

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