Essential Anatomy for the Abdominal Wall Surgeon: Expert Consensus of Anatomical Concepts and Operative Steps for Posterior Component Separation

Introduction: Abdominal wall surgery is emerging as a new subspecialty with reconstructive operations becoming increasingly complex. Central to any surgical subspecialty is comprehensive anatomical knowledge, which can be enhanced by cadaver dissection. An expert panel convened to develop a consensus framework highlighting key anatomical concepts and operative steps for teaching posterior component separation. Methods: The panel consisted of opinion leading abdominal wall surgeons from the UK and Europe. Intellectual content derived from anatomy lectures, training videos, and cadaver dissection instructions formed the basis of the consensus framework. This framework was subsequently implemented during a pilot cadaveric workshop. Afterward, content from the workshop was further refined, resulting in this educational article, endorsed by all authors. This article comprises two sections, (1) theoretical aspects of abdominal wall anatomy; (2) stepwise technical guidance for cadaver dissection. Results: In the first section, “Essential Anatomy,” we discuss: Anterior abdominal wall musculature, posterior abdominal wall, the semilunar line, preperitoneal space, subxiphoid anatomy and pelvic anatomy. In the second section, “Practical Anatomy taught via Cadaver Dissection,” we discuss: Rives-Stoppa dissection, caudal extension, cranial extension, classic top-down transversus abdominis release and posterior component separation with Madrid modification (bottom-up or “Madrid PCS”). Conclusions: Using content delivered by senior members of the abdominal wall reconstruction community, this article provides a structured educational framework for teaching posterior component separation. This is intended as a reference guide for surgical training and details the essential anatomical and operative concepts every abdominal wall surgeon should know.