Clinical scienceTransversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction
Section snippets
Materials and Methods
We performed a retrospective review of all patients undergoing hernia repair at the specialized hernia repair center by a single surgeon (Y.W.N.). Patients who underwent abdominal wall reconstruction using retromuscular synthetic mesh repair with TAR were identified and reviewed.
Main outcome measures included patient demographics, body mass index, number of previous abdominal surgeries, number of recurrent hernias, and number of previous hernia repairs. Perioperative data included surgical time
Results
Between December of 2006 and December 2009, we used the TAR technique in 42 patients with complex ventral hernia defects. There were 32 (76%) women with a mean age of 52.1 years. The average body mass index was 39 ± 13 kg/m2 (range, 23–69 kg/m2). The average defect size was 366 ± 120 cm2 (range, 160–660 cm2). Thirty-two (76.2%) patients had recurrent hernias with an average number of previous repairs of 2.9 (range, 1–8). Thirty (71.4%) patients had chronically incarcerated hernias. Thirteen
Comments
The ideal surgical approach to the difficult ventral hernia repairs remains to be elucidated. Complex abdominal problems continue to present a significant technical challenge with high perioperative morbidity, frequent repair failures, and negative effects on patient quality of life.18 Similarly to others, we believe that the goal of any herniorrhaphy should be restoration of a functional abdominal wall with autologous tissue repair strengthened by reinforcement with a durable mesh.18 Our novel
Conclusions
Herein we presented our novel technique of abdominal wall reconstruction using a transversus abdominis muscle release. This approach is a modification of a posterior component separation and is an adjunct to the traditional retromuscular repair of Rives-Stoppa. It was associated with low perioperative morbidity and a low-recurrence rate in our challenging group of patients. The advantages of this approach include the ability for extensive lateral extension of the retromuscular plane beyond the
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