The optimal technique to repair large incisional hernias remains debatable. Both open and laparoscopic component separation techniques have been described, each with their own unique advantages and disadvantages. We present a novel combination utilizing both the open component separation with adhesiolysis and laparoscopic intraabdominal mesh insertion.

Our technique is demonstrated in a 63 year old male who presented with a second recurrence of an incisional hernia measuring 20x22 cm. After laparotomy and adhesiolysis, we perform a component separation, with lateral incision of the external oblique fascia. Prior to the closure of the fascia, four 5 mm trocars are inserted. A two-sided mesh is selected and sized to assure overlap beyond the lateral relaxing incisions. The mesh is inserted loose into the abdominal cavity, and the fascia is then closed. Laparoscopically, the mesh is secured to the abdominal wall with good overlap of even the lateral relaxing incisions. Transfascial sutures do not require any additional skin stab incisions.

After discharge on day 2, he had a seroma postoperatively which drained spontaneously without recurrence. Otherwise, he was complication-free and regained full range of motion of his abdominal wall. There is no evidence of recurrence at his 3 month follow-up visit.

A blend of open and laparoscopic techniques to repair a large or complex incisional hernia requiring a component separation offers the potential benefits of both procedures. This combined technique is straightforward to learn, permits a safe adhesiolysis, and may reduce recurrence rates. Further studies are required.