How we do it: down to up posterior components separation

Abstract

This novel modification allows a simpler dissection of the preperitoneal retromuscular space and makes the TAR technique easier to perform. It also enables to incise only the insertion of the transversalis fascia cranially.

Outcomes of abdominal wall reconstruction in patients with the combination of complex midline and lateral incisional hernias

“…Lessons learned with PCS techniques and work with cadavers have taught us that lateral defects can also be reached and treated through the midline (Fig 7). After the retrorectal dissection, the lateral retromuscular preperitoneal plane is reached from the midline using the TAR approach to find the lateral defect 31,32 and dissected in a centripetal way from previously nondissected retromuscular preperitoneal areas toward the hernia defect. For example, in a lumbar hernia, we can dissect the subdiaphragmatic plane cranially, the preperitoneal Retzius and Bogros spaces caudally, and posterior to the transverse abdominus muscle medially before dissecting circumferentially and reducing the lumbar sac.…”

“…Furthermore, we encourage attempting to use the modification of the TAR. This modification preserves the TA muscle and allows the possibility of reinsertion of the lateral border of posterior rectus sheath to the mesh 32 in an already weak lateral abdominal wall. In fact, nowadays, this technique is our preferred choice in PCS, when feasible.…”

“…A classic transversus abdominis release (TAR) 31 or a modification of the TAR, 32 which avoids cutting the fibers of the transversus abdominis, were performed as described previously. The lateral dissection continues to the extent of the defect of the lateral IH (Fig 1).…”

Evaluation of a workshop to teach a new surgical technique in abdominal wall reconstruction

“…Five surgeons of the team are involved in the management of the complex abdominal wall and all of them have broad experience in TAR. We perform the TAR with some slight modifications that we have previously published [6]. The hospital receives patients with complex abdominal wall problems from all over the country.…”

Robotische Hernienchirurgie II

“…Abb 2 8. Planung der robotischen transabdominellen retromuskulären umbilikalen Patchplastik (r-Rives bzw.r-TARUP)vonlinkslateral.a ChecklistefürLagerung,TargetingundPortpositionierung.bDas Anlegen des Pneumoperitoneums mit der Veres-Nadel ist bereits erfolgt, Umbilikalhernie und geplan-teNetzgrößesindmitdemStiftmarkiertundmitNadelnnachintraabdominellextrapoliert.cAnatomie des r-Rives/r-TARUP: Die Ports werden weit lateral des linksseitigen M. rectus abdominis positioniert, der graue Pfeil zeigt den Weg der Präparation; 1 lateraler Einstieg in die linke hintere Rektusscheide (grüne Punkte); 2 im Bereich der Dekussierung beider Rektusscheidenblätter wird das hintere Blatt erneut eröffnet (rote Punkte), U Umbilikalhernie; 3 nach dem Freilegen der Linea alba und der Bruchlücke wird in die hintere rechtsseitige Rektusscheide medialseitig eingegangen (blaue Punkte); 4 im lateralen Bereich müssen die Nerven erhalten bleiben; 5 mobilisierter Bruchsack mit medianer peritonealer Brücke zwischen beiden hinteren Rektusscheiden…”