R Punjani1, E Arora2, R Mankeshwar3, J Gala4. 1. Fortis Healthcare, Mumbai, India. 2. Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, 6th Floor, Main Hospital Building, Sir JJ Hospital Campus, Byculla, Mumbai, 400008, India. ehamarora@gmail.com. 3. Department of Preventive and Social Medicine, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, India. 4. Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, 6th Floor, Main Hospital Building, Sir JJ Hospital Campus, Byculla, Mumbai, 400008, India.
Abstract
BACKGROUND: Transversus abdominis release (TAR) is a relatively recent surgical technique for ventral hernia repair which allows placement of a large prosthesis in the retro-muscular plane with considerable myofascial medialization. A retrospective review of 100 cases who underwent TAR for complex ventral hernias was performed to evaluate the safety and efficacy of TAR in a series of large ventral hernias. METHODS: Between March 2016 and May 2019, 100 consecutive patients who underwent open TAR were identified from our prospectively maintained database. A retrospective review was performed to analyze patient demographics, peri-operative events, adverse outcomes and recurrence. RESULTS: 12 primary and 88 incisional hernia cases underwent TAR with prosthetic mesh repair during the study period. Mean age was 52.5 years, mean BMI was 30.87 kgs/m2, mean ASA class 1.95. In our series, 41% were diabetic, 11% had COPD. All patients underwent preoperative CT scans. The mean defect was 140.18 cm2. Average mesh area was 1344 cm2. Average blood loss was 245 mL. Defects were bridged in 19% cases despite bilateral component separation. Readmission rate at 1 month was 3%, for wound complications. We recorded 9 surgical site infections, 17 surgical site occurrences, 10 of which needed procedural interventions. We recorded no recurrences at a mean follow-up duration of 20.2 months. CONCLUSIONS: Our early results with TAR are encouraging. We have demonstrated that the repair allows anatomical reconstruction with a large sublay mesh while inflicting minimal morbidity. TAR can be a valuable tool in complex ventral hernia repair.
BACKGROUND: Transversus abdominis release (TAR) is a relatively recent surgical technique for ventral hernia repair which allows placement of a large prosthesis in the retro-muscular plane with considerable myofascial medialization. A retrospective review of 100 cases who underwent TAR for complex ventral hernias was performed to evaluate the safety and efficacy of TAR in a series of large ventral hernias. METHODS: Between March 2016 and May 2019, 100 consecutive patients who underwent open TAR were identified from our prospectively maintained database. A retrospective review was performed to analyze patient demographics, peri-operative events, adverse outcomes and recurrence. RESULTS: 12 primary and 88 incisional hernia cases underwent TAR with prosthetic mesh repair during the study period. Mean age was 52.5 years, mean BMI was 30.87 kgs/m2, mean ASA class 1.95. In our series, 41% were diabetic, 11% had COPD. All patients underwent preoperative CT scans. The mean defect was 140.18 cm2. Average mesh area was 1344 cm2. Average blood loss was 245 mL. Defects were bridged in 19% cases despite bilateral component separation. Readmission rate at 1 month was 3%, for wound complications. We recorded 9 surgical site infections, 17 surgical site occurrences, 10 of which needed procedural interventions. We recorded no recurrences at a mean follow-up duration of 20.2 months. CONCLUSIONS: Our early results with TAR are encouraging. We have demonstrated that the repair allows anatomical reconstruction with a large sublay mesh while inflicting minimal morbidity. TAR can be a valuable tool in complex ventral hernia repair.
Entities:
Keywords:
Abdominal wall reconstruction; Component separation; Hernia repair; Loss of domain; Retrospective review; Transversus abdominis release; Ventral hernia
Authors: R W Luijendijk; W C Hop; M P van den Tol; D C de Lange; M M Braaksma; J N IJzermans; R U Boelhouwer; B C de Vries; M K Salu; J C Wereldsma; C M Bruijninckx; J Jeekel Journal: N Engl J Med Date: 2000-08-10 Impact factor: 91.245
Authors: C Fink; P Baumann; M N Wente; P Knebel; T Bruckner; A Ulrich; J Werner; M W Büchler; M K Diener Journal: Br J Surg Date: 2013-11-26 Impact factor: 6.939
Authors: Yuri W Novitsky; Mojtaba Fayezizadeh; Arnab Majumder; Ruel Neupane; Heidi L Elliott; Sean B Orenstein Journal: Ann Surg Date: 2016-08 Impact factor: 12.969
Authors: Yuri W Novitsky; Justin R Porter; Zach C Rucho; Stanley B Getz; Broc L Pratt; Kent W Kercher; B Todd Heniford Journal: J Am Coll Surg Date: 2006-07-13 Impact factor: 6.113