TY - JOUR
T1 - Transversus abdominis release with posterior component separation in patients with previously recurrent ventral hernias
T2 - A single institution experience
AU - Han, Britta J.
AU - Kushner, Bradley S.
AU - Holden, Sara E.
AU - Majumder, Arnab
AU - Blatnik, Jeffrey A.
N1 - Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2022/3
Y1 - 2022/3
N2 - Background: Recurrent hernias pose significant challenges due to violated anatomic planes, resultant scar, and potential prior mesh. Transversus abdominis release has been widely utilized for complex hernias. Transversus abdominis release can provide a novel plane for dissection and mesh placement for recurrent hernias. This study provides our institution's experience with transversus abdominis release in patients with recurrent ventral hernias. Methods: A retrospective chart review was conducted of patients with recurrent ventral hernias from January 2018 to September 2020 who underwent transversus abdominis release by 2 fellowship-trained abdominal wall surgeons. Combined procedures (ie, gynecological/urological), robotic totally extraperitoneal, and emergency cases were excluded. Demographics, perioperative, and postoperative outcomes were reviewed. Results: In total, 108 patients underwent open-transversus abdominis release and 25 had robotic-transversus abdominis release for recurrent ventral hernias. All patients received a lightweight to midweight nonabsorbable polypropylene synthetic mesh. Mean age was 59, mean body mass index was 34 kg/m2, with mean hernia defect area of 333 cm2. We noted 34 (25.6%) surgical site occurrences and 11 (8.3%) surgical site infections. Mean postoperative follow-up was 15.5 months, with 7 (5%) recurrences (6 open-transversus abdominis release, 1 robotic-transversus abdominis release). A minimum 12-month follow-up was available for 62% of patients, and minimum 6-month follow-up in 80% of patients. Conclusion: Recurrent hernias pose significant operative challenges for surgeons due to violated tissue planes and limited repair options. Our experience suggests that transversus abdominis release may provide a durable repair for difficult recurrent ventral hernias. However, long-term postoperative follow-up over multiple years is still needed to establish extended durability of transversus abdominis release in these patients.
AB - Background: Recurrent hernias pose significant challenges due to violated anatomic planes, resultant scar, and potential prior mesh. Transversus abdominis release has been widely utilized for complex hernias. Transversus abdominis release can provide a novel plane for dissection and mesh placement for recurrent hernias. This study provides our institution's experience with transversus abdominis release in patients with recurrent ventral hernias. Methods: A retrospective chart review was conducted of patients with recurrent ventral hernias from January 2018 to September 2020 who underwent transversus abdominis release by 2 fellowship-trained abdominal wall surgeons. Combined procedures (ie, gynecological/urological), robotic totally extraperitoneal, and emergency cases were excluded. Demographics, perioperative, and postoperative outcomes were reviewed. Results: In total, 108 patients underwent open-transversus abdominis release and 25 had robotic-transversus abdominis release for recurrent ventral hernias. All patients received a lightweight to midweight nonabsorbable polypropylene synthetic mesh. Mean age was 59, mean body mass index was 34 kg/m2, with mean hernia defect area of 333 cm2. We noted 34 (25.6%) surgical site occurrences and 11 (8.3%) surgical site infections. Mean postoperative follow-up was 15.5 months, with 7 (5%) recurrences (6 open-transversus abdominis release, 1 robotic-transversus abdominis release). A minimum 12-month follow-up was available for 62% of patients, and minimum 6-month follow-up in 80% of patients. Conclusion: Recurrent hernias pose significant operative challenges for surgeons due to violated tissue planes and limited repair options. Our experience suggests that transversus abdominis release may provide a durable repair for difficult recurrent ventral hernias. However, long-term postoperative follow-up over multiple years is still needed to establish extended durability of transversus abdominis release in these patients.
UR - http://www.scopus.com/inward/record.url?scp=85121692970&partnerID=8YFLogxK
U2 - 10.1016/j.surg.2021.08.067
DO - 10.1016/j.surg.2021.08.067
M3 - Article
C2 - 34949463
AN - SCOPUS:85121692970
SN - 0039-6060
VL - 171
SP - 806
EP - 810
JO - Surgery (United States)
JF - Surgery (United States)
IS - 3
ER -