Comparing the outcomes of external oblique and transversus abdominus release using the AHSQC database

Bilezikian, Jordan A; Tenzel, Paul; Faulkner, Justin; Bilezikian, M J; Powers, William F.; Hope, William W.

doi:10.1007/s10029-020-02310-7

Cited by 9 publications

(5 citation statements)

References 21 publications

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“…This approaches these rates, although those studies did not take a 90-day inclusion period, systemic complications, readmissions or recurrences into account. Wound complications reported in comparable studies (SSO 3-39%, SSE 3-14%, SSOPI 3-12%) resemble the results reported here, except for SSE (23%), which was high in the first episode (8,11,13,15,18,20,(45)(46)(47)(48)(49). While SSE is underreported in most studies, and no specific cause can be designated, this may be related to the TAR learning curve (8,13,15,48,49).…”

Section: Evaluation Of Outcomessupporting

confidence: 78%

“…Larger cohort studies or data from national registries, varying from 184 to 3109 TAR cases, demonstrated slightly better outcomes than the smaller series: SSO 18-31%, SSE 19%, SSOPI 5-9% and recurrence 3-4% (6,10,18,19,50,51), which may be due to some learning curve effect.…”

Section: Evaluation Of Outcomesmentioning

confidence: 81%

“…The TAR is also a myofascial release intended to decrease midline tension, but has an improved overlap of large defects and hernias near bony structures. The safe plane in which the mesh is positioned and lack of extended subcutaneous dissection are also assets (17,18). Because TAR seemed to have less surgical site occurrences and recurrences than Ramirez, TAR became popular in many hernia centers over the world (10,11,19,20).…”

Section: Introductionmentioning

confidence: 99%

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Assessing Textbook Outcome After Implementation of Transversus Abdominis Release in a Regional Hospital

Wegdam

Jong

Reilingh

et al. 2022

J. Abdom. Wall Surg.

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Background: The posterior component separation technique with transversus abdominis release (TAR) was introduced in 2012 as an alternative to the classic anterior component separation technique (Ramirez). This study describes outcome and learning curve of TAR, five years after implementation of this new technique in a regional hospital in the Netherlands.Methods: A standardized work up protocol, based on the Plan-Do-Check-Act cycle, was used to implement the TAR. The TAR technique as described by Novitsky was performed. After each 20 procedures, outcome parameters were evaluated and new quality measurements implemented. Primary outcome measure was Textbook Outcome, the rate of patients with an uneventful clinical postoperative course after TAR. Textbook Outcome is defined by a maximum of 7 days hospitalization without any complication (wound or systemic), reoperation or readmittance, within the first 90 postoperative days, and without a recurrence during follow up. The number of patients with a Textbook Outcome compared to the total number of consecutively performed TARs is depicted as the institutional learning curve. Secondary outcome measures were the details and incidences of the surgical site and systemic complications within 90 days, as well as long-term recurrences.Results: From 2016, sixty-nine consecutive patients underwent a TAR. Textbook Outcome was 35% and the institutional learning curve did not flatten after 69 procedures. Systemic complications occurred in 48%, wound complications in 41%, and recurrences in 4%. Separate analyses of three successive cohorts of each 20 TARs demonstrated that both Textbook Outcome (10%, 30% and 55%, respectively) and the rate of surgical site events (45%, 15%, and 10%) significantly (p < 0.05) improved with more experience.Conclusion: Implementation of the open transversus abdominis release demonstrated that outcome was positively correlated to an increasing number of TARs performed. TAR has a long learning curve, only partially determined by the technical aspects of the operation. Implementation of the TAR requires a solid plan. Building, and maintaining, an adequate setting for patients with complex ventral hernias is the real challenge and driving force to improve outcome.

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Section: Evaluation Of Outcomessupporting

confidence: 78%

Section: Evaluation Of Outcomesmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Assessing Textbook Outcome After Implementation of Transversus Abdominis Release in a Regional Hospital

Wegdam

Jong

Reilingh

et al. 2022

J. Abdom. Wall Surg.

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“…The TAR technique is characterized as a posterior myofascial release decreasing tension on the linea alba reconstruction, creating a large retromuscular space by extending dissection beyond the semilunar line that allows placement of a large mesh and preservation of the neurovascular bundles to protect the abdominal wall blood supply [12,14,19].…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies comparing ACS and TAR have showed similar one-year recurrence rates, quality of life, and SSI rates in both techniques, whereas surgical site occurrences were higher in ACS. However, it has been reported that ACS had more severe wound complications and required more extended hospital stays than TAR [19,22]. Laparoscopic and robotic approaches have been described and adopted in the TAR technique and have become popular among hernia surgeons, especially in the US [23][24][25][26].…”

Section: Discussionmentioning

confidence: 99%

Open posterior component separation with transversus abdominis release (TAR) for large incisional abdominal wall hernias: Results from a single center

Taşdelen¹

2022

Med-Science

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Transversus abdominis release (TAR) is the newest approach that allows effective myofascial mobilization, creating a large retromuscular space and wide mesh overlap to repair complex and large incisional ventral hernias. This article narrates the technical details and results of the TAR technique performed in a single center. The present study is a retrospective analysis of a prospective dataset from 25 patients who underwent posterior component separation (PCS) with TAR procedure for large incisional ventral hernias between October 2017 and July 2021. The minimum follow-up period was ten months. Twenty-five patients (five male, 20 female) with a mean age of 61.2 years, a mean BMI of 32.2 kg/m2, and a median ASA score of 2.0 underwent the TAR procedure. Fifteen (60%) patients had a history of incisional hernia surgery. The mean surgical time was 248 minutes. The mean total defect and mesh areas were 187.4 (90-500) cm2 and 1141.8 (750-2250) cm2, respectively. The mean visual analog scale (VAS) pain score on the first postoperative day was 4.5 and the median hospital length of stay (LOS) was 5 days. There were three (12%) surgical site infections (SSIs), two of which were deep infections that needed debridement. During the follow-up period (median of 26 months), two (8%) recurrences were recorded. The TAR technique represents an effective and safe repair modality of large and complex incisional hernias. TAR is an essential addition to the repertoire of the surgical community.

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Outcomes of open transverse abdominis release for ventral hernias: a systematic review, meta-analysis and meta-regression of factors affecting them

Vasavada¹,

Patel²

2022

Hernia

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Comparing the outcomes of external oblique and transversus abdominus release using the AHSQC database

Cited by 9 publications

References 21 publications

Assessing Textbook Outcome After Implementation of Transversus Abdominis Release in a Regional Hospital

Assessing Textbook Outcome After Implementation of Transversus Abdominis Release in a Regional Hospital

Open posterior component separation with transversus abdominis release (TAR) for large incisional abdominal wall hernias: Results from a single center

Outcomes of open transverse abdominis release for ventral hernias: a systematic review, meta-analysis and meta-regression of factors affecting them

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