Component separation is a technique used to repair complex ventral hernias by medializing the retracted rectus abdominis muscle to the midline following transecting of the external oblique muscle. The open technique is associated with significant wound related complications due to the extensive dissection needed. This video illustrates the procedure been performed completely laparoscopically.

Preoperative photographs demonstrate the hernia defect in a 54 year old male who developed the hernia following a laparotomy for a perforated duodenal ulcer. The defect was greater than 15 cm in width. The procedure consists of 4 distinct phases. Phase 1 - is the component separation performed laparoscopically with 3 trocars placed on either side of the abdomen. Phase II - consists of hernia content reduction. Phase III - consists of primary suture repair of the both rectus abdominis muscles in the midline. Phase IV - consists of laparoscopic mesh placement and fixation.

Our edited video demonstrates a successful laparoscopic component separation followed by a laparoscopic hernia repair with a primary suture and reinforcement with mesh. The operative time was 4.5 hours. The hospital stay was 4 days. Postoperative photographs and video demonstrate successful repair of the hernia. A postoperative CT scan demonstrates the division of the external oblique muscle and hernia repair.

This minimally invasive approach allows direct access to the lateral component, avoids a large subcutaneous flap dissection and division of the abdominal wall perforators thereby decreasing the complexity of postoperative wound complications that are associated with the open technique.