Transversus Abdominus Release for Abdominal Wall Reconstruction: Early Experience with a Novel Technique
Brittany Behar, MD, Ryan Juza, MD, Trevor Jackson, B.A., Brett Michelotti, MD, John Potochny, MD, Eric Pauli, MD.
Penn State Hershey Medical Center, Hershey, PA, USA.
Ventral hernias are an increasingly common and complex problem. Despite the frequent use of anterior component separation, recurrence rates remain high. Our aim is to describe our experience with a novel method of component separation: transversus abdominis release (TAR).
A review of a prospectively collected database was completed. Patients who underwent component separation herniorraphy with TAR at our hospital were identified. Patient demographics, peri- and post-operative events were evaluated.
Briefly, the posterior rectus sheath is dissected laterally to linea semilunaris. The transversus abdominus is divided with electrocautery revealing the pre-peritoneal/transversalis fascial plane. Domain is re-established by closing the peritoneum over bowel; mesh is placed in a retro rectus position. Ultimately the anterior rectus sheath is closed primarily.
Thirty-four patients with a median BMI of 33.4 kg/m2 were identified. Nineteen patients underwent prior hernia repair with one previous anterior component separation. Hernias were located in the following locations: midline (76%), suprapubic (6%) parastomal (24%) and at the inguinal canal(3%). All patients underwent repair with mesh. Median defect size was 416 cm2 (range 6.25-2700 cm2). Rectus medialization was achieved in 97%. The median length of stay was 7 days. Median follow up was 8.8 months which includes CT scan at 1 and 12 months. One hernia recurred in a patient with a previous parastomal hernia.
Short-term follow-up after TAR herniorraphy demonstrates a low rate of recurrence. Transversus abdominus release is a safe option for repair of eventrations of the abdominal wall, including those with prior anterior component separation.
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