Several techniques have been described to increase the abdominal cavity volume [18], including tissue expanders, botulinum toxin, component separation techniques (CST) and progressive preoperative pneumoperitoneum (PPP).

The different component separation techniques (CST) are extensively reported and well described for the surgical treatment of IHLD [19–28] and are rapidly becoming the technique of choice in complex ventral hernia repair, even sometimes considered as a standard for the repair of all midline incisional hernias [25, 29–31]. The rst technique described was anterior CST, reported by Ramirez etal. [32, 33]. In this technique, the external oblique muscle aponeurosis is sectioned near the semilunar line, allowing advancement of the composite ap of the ipsilateral rectus muscle medially to the midline. More recently, Novitsky etal. [19] described the transversus abdominis release (TAR). This technique consists in an extension of the Rives-Stoppa technique where the transversus abdominis muscle insertion is sec­tioned near the semilunar line, allowing the creation of a plane laterally between the transversus abdominis muscle and the transversalis fascia. The TAR, also called “perforator preserving CST” [29], is a safe alternative to the posterior component separation described by Carbonell et al. [20] where the lateral plane is created between the internal oblique and the transversus abdominis muscle, thus affecting the abdominal perforator nerves and vessels.