Longitudinal Clinical and Patient-Reported Outcomes After Transversus Abdominis Release for Complex Hernia Repair With a Review of the Literature

Abstract

Purpose Posterior component separation with transversus abdominis release (TAR) enables medial myofascial flap advancement in complex abdominal wall reconstruction. Here, we add to a growing body of literature on TAR by assessing longitudinal clinical and patient-reported outcomes (PROs) after complex ventral hernia repair (VHR) with TAR. Methods Adult patients undergoing VHR with TAR between 10/15/2015 and 1/15/2020 were retrospectively identified. Patients with parastomal hernias and <12 months of follow-up were excluded. Clinical outcomes and PROs were assessed. Results Fifty-six patients were included with a median age and body mass index of 60 and 30.8 kg/m2, respectively. The average hernia defect was 384 cm2 [IQR 205-471], and all patients had retromuscular mesh placed. The most common complications were delayed healing (19.6%) and seroma (14.3%). There were no cases of mesh infection or explantation. Previous hernia repair and concurrent panniculectomy were risk factors for developing complications ( P < .05). One patient (1.8%) recurred at a median follow-up of 25.2 months [IQR 18.2-42.4]. Significant improvement in disease-specific PROs was maintained throughout the follow-up period (before to after P < .05). Conclusion Transversus abdominis release is a safe and efficacious technique to achieve fascial closure and retromuscular mesh in the repair of complex hernia defects.

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

“…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). The rate of patients without any systemic complication cannot be deduced in any other study, nor can it be adequately compared with our results.…”

“…Textbook Outcome increased to 55% and rate and severity of both wound and systemic and complications was further reduced: SSO to 20% (p = 0.03), SSE 10% (p = 0.02), SSOPI 5% (p = 0.07), Unintended contamination of the surgical field (complete bowel lesions), n (%) 3 (15) 3 ( 43) 1 ( 10) 1 ( 25) 8 ( 28) 0.728…”

“…Latest alteration in component separation techniques is the transversus abdominis release (TAR) (8)(9)(10)(11)(12)(13)(14)(15). This posterior CST was introduced in 2012 as an alternative to the classic anterior component separation technique (Ramirez) (8,16).…”

“…Division of incorrect layers lead to neurovascular lesions, semilunar hernias, interparietal herniation, and recurrences. Multiple authors mentioned a learning curve of the TAR and advised implementation only after adequate training and proctoring of the first 5-15 cases, depending on the experience in open Rives-Stoppa repair (9)(10)(11)(12)(13)(14)(15).…”

Comparative Analysis of Ventral Hernia Repair and Transverse Abdominis Release With and Without Panniculectomy

“…Numerous studies have affirmed the positive short-term outcomes of TAR in terms of QoL, recurrence rates, and functionality, solidifying its status as an effective surgical solution for large and complex abdominal defects. [21][22][23][24][25][26][27] Surgical site occurrences tended to occur at similar rates to other VHR techniques. Seroma and delayed healing were the most frequently reported complications, whereas more severe complications such as mesh explanation and reoperations occur less frequently.…”