Feasibility of Posterior Component Separation with Transversus Abdominis release in complex ventral hernias : outcomes and experience at a single centre

Abstract

Introduction : Complex ventral hernias are a challenging entity which require some form of myofascial separation to achieve a tension free repair and adequate mesh placement. Posterior component separation with transversus abdominis release (TAR) has come up as an exciting tool in achieving the same albeit preserving the neurovascular arcade and recording lesser wound morbidity. In this study, we present our experience with this technique whilst operating on patients with complex ventral hernias.

Methodology : 20 patients requiring TAR (based upon the pre-operative imaging fulfilling the required criteria of defect width or size or the intra-operative need) were included in the study extending from January 2021 to April 2023. All the patients were operated at a single centre by the same surgical team.

Results : Majority of the patients were females (12; 60%) with a mean age of 56.4 years, a mean BMI of 28.8kg/m² and a median ASA score of 2. Three of these patients had loss of domain. Fifteen (75%) patients had a history of previous surgery (incisional hernia). The mean defect width and total defect area were 10.8 + 2.16 cm and 193 + 20.45 (110-450) cm², respectively. The mean surgical time was 207 minutes with an average of 7.8cm of medialisation of linea alba achieved. The mean visual analog scale (VAS) pain score on the first postoperative day was 4.2 and the median hospital length of stay (LOS) was 5 days. There were only four (20%) cases of minor wound related complications which were managed conservatively with no major complication/ re-surgery recorded. During the follow-up period (mean of 21.6 months), only one (5%) recurrence was recorded.

Conclusion : TAR offers an excellent option in managing complex and large ventral hernias with fairly less complications and wound morbidity adding to the armamentarium of the hernia surgeon.