Complications - Component separation according to Ramirez

  1. Intraoperative Complications

    • Intraoperative Bleeding
      Especially of the epigastric vessels or their branches at the lateral edge of the rectus sheath

      Therapy: immediate suturing/hemostasis
       
    • Bowel Injury during Adhesiolysis
      Prophylaxis: careful, layer-by-layer preparation, if necessary, start preparation in the defect-free area, from there display the fascial defect and the hernia contents. Early opening of the hernia sac.

      Deserosations must be recognized and immediately oversewn.

      In the case of transmural lesions, the location (small intestine-large intestine) and the amount of bowel content leakage are decisive; if necessary, postpone the mesh implantation.
       
    • Inability to Close the Anterior Rectus Sheath

      Bridging Technique: In the event that the anterior fascial layers cannot be completely united, fixation of the fascial edges on the mesh already placed in the sublay position with a continuous non-absorbable suture in the sense of partial anterior bridging is permissible. If a large hernia is treated with a dorsal fascial closure, a sublay mesh in a retromuscular position, and a small residual bridging of the anterior fascia, and a primary skin closure is achieved over it, a satisfactory result can be assumed.
Postoperative complications

Rebleeding/Hematoma Ultrasound monitoring, puncture if size progresses. Hemoglobin-relevant rebleed

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