الفهرس 
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Abstract
Ventral hernia repair is one of the most common operations performed today, yet when complex and huge it presents a true challenge for surgical team.
Incisional hernia is an important complication of abdominal surgery with an incidence of 10–23 %, after midline laparotomy increasing up to 38 % in specific risk groups. Incisional hernia can lead to pain, discomfort and cosmetic complaints, resulting in a decreased quality of life. Moreover, incisional hernia can cause incarceration and strangulation of abdominal contents, requiring emergency surgery, with associated morbidity and mortality. Mid line laparotomy is associated with highest incidence of developing incisional hernia and sometimes huge being true challenge for the surgeons to perform functional restoration of abdominal wall with autologous tissue repair that’s followed by mesh reinforcement.
For these reasons the component separation techniques have gained popularity among general surgeons in the management of giant abdominal hernia. TAR technique is an important modification of posterior component separation while perforator preservation technique is an important add to ACS. With the multitude of operative approaches and variability amongst patients and hernias, defining a single, ideal operative approach is challenging and possibly unrealistic for ventral hernia repair.
Based on our prospective randomized study, a few preliminary conclusions can be made. There was no significant difference in most of outcomes between patients underwent repair with TAR technique or with perforator preserving component separation when using the same type of polyprolene mesh and at the same retromuscular position.
Perforator preserving technique has less operative time by about 40 minutes when compared with TAR technique as the mean operative time in TAR was 268.5± 47.4 min (4hr28min) with SD while in perforator preserving technique, it was 228.3± 68.8min (3hrs48min).
The postoperative pain assessment at 48hrs postoperative show that the mean VAS score for TAR group A was (6.77 ±
1.70) and for group B (5.47 ± 1.85).
We also found that the mean hospital stay was slightly higher when performing TAR technique (5.2days) while it was (4.3days) after perforator preserving approach.
There is nearly equal incidence of postoperative wound complications and also no statistically significant different rate of recurrence between two methods, and the rate of wound complication and recurrence are significantly lower than the classic commonly used method of anterior components separation.
In conclusion, after this comparative study, both TAR and perforator preserving technique are effective and reliable method in experienced hands and if there is no special indication to one of them, the choice between both should depend on surgeon preference and experience