I read with interest the study by Itani et al1 comparing the laparoscopic and open repair of incisional hernias. As Halvorson states,2 the components-separation technique was originally described by Ramirez et al in 1990 and it needs wide cutaneous flaps rising at least to the junction of the lateral border of rectus sheath and the external oblique aponeurosis. This wide subcutaneous dissection may be the main cause of seroma formation after this technique.
Mohammadhosseini B. Open Mesh Repair of Ventral Incisional Hernias With Tacker With Less Complication. Arch Surg. 2010;145(10):1021-1022. doi:10.1001/archsurg.2010.200