Discussion: Fight or Flight: The Role of Staged Approaches to Complex Abdominal Wall Reconstruction

What is it about?

In clean contaminated and contaminated complex ventral hernias, a single stage operation when performing concomitant procedures is best performed with a retrorectus synthetic mesh with closure of the posterior rectus fascia. Transversus abdominus fascial release is the best approach to achieve fascial approximation in the midline but requires significant experience by the operating surgeon. Components separation should not be undertaken unless definitive reconstruction is planned. Staged operations should be reserved for patients with gross contamination, poor nutrition or poor medical conditions.

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