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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.

PURPOSE:
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).
METHODS:
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.
RESULTS:
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.
CONCLUSION:
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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