Introducere: Cura herniilor incizionale de dimensiuni mari reprezintã o problemã provocatoare æi complexã. Procedura de separare posterioarã a componentelor completatã cu augmentarea proteticã æi restaurarea liniei albe reprezintã o direcåie inovatoare de reconstrucåie peretelui abdominal. Materiale æi metode: În perioada 2019-2020 am utilizat procedura de separare posterioarã a componentelor cu eliberarea muæchiului transvers abdominal (TAR) la 10 pacienåi (4 de sex masculin) cu hernii incizionale voluminoase. Repartiåia defectelor parietale conform clasificãrii EHS (2009): M1W3 (n=4), M2W3 (n=2), M3W3(n=1), M5 W3 (n=1 ) æi L2W3 (n=2). Dimensiunea medie a lãåimii defectului parietal a constituit 15,5 cm (interval 12,5- 19,0 cm). Procedura prevede incizia longitudinalã la nivelul foiåei posterioare a tecii dreptului abdominal, disecåia dreptului abdominal cu crearea spaåiului retromuscular, eliberarea componentului fascial transvers medial de la linia semilunarã æi crearea unui spaåiul preperitoneal avascular extins æi cu montarea protezei textile din polipropilenã monofilament de mari dimensiuni în poziåie preperitonealã. Rezultate:Complicaåii parietale au fost instalate la 4 pacienåi. Timpul mediu de urmarire a fost 18 luni fãrã recidivã. Concluzii: Procedeu de separare posterioarã a componentelor oferã soluåia eficientã în tratamentul eventraåiilor voluminoase æi asigurã restabilirea structuralã æi funcåionãlã a peretelui abdominal.

Introduction: Giant incisional hernia repair is a complex and challenging issue. Posterior component separation technique with transversus abdominis muscle release augmented by surgical mesh represents a novel approach to ventral hernia. Materials and methods: During the period from 2019 to 2020 we used the posterrior component separation technique with transvers abdominis muscle release (TAR) in 10 patients (4 males) with giant ventral incisional hernias. According to EHS (2009) classification, the hernias were classified as type M1W3 (n=4), M2W3 (n=2), M3W3 (n=1), M5 W3 (n=1) æi L2W3 (n=2). The average width of the defect was 15,5 cm (range 12,5- 19,0 cm).The procedure includes a Rives-Stoppa retro-rectus dissection followed by the transversus abdominis release medial to the linia semilunaris, wide plane of pre-peritoneal dissection and placement ofa suitably dimensioned surgical mesh in preperitoneal fashion. Results: We observed 4 cases of various types of wound complications. Patients were evaluated at a median follow up of 18 month without recurrence. Conclusions: Posterior component separation is versatile technique that provides high-level functionality of the abdominal walland offers reliable solution for complex incisional hernias.