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Outcomes of transversus abdominis release (TAR) with permanent synthetic retromuscular reinforcement for bridged repairs in massive ventral hernias: a retrospective review

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Abstract

Purpose

In a subset of patients with massive and multiply recurrent hernias, despite performing a transversus abdominis release (TAR), anterior fascial re-approximation is not feasible and a bridged repair is required. We aim to report on the outcomes of this patient population at our institution.

Methods

Patients that underwent a TAR-bridged repair at the Cleveland Clinic were identified retrospectively within the Americas Hernia Society Quality Collaborative (AHSQC) database. Outcomes of interest were quality-of-life metrics measured through HerQLes and PROMIS pain intensity 3a and composite recurrence measured by patient-reported outcomes, physical examination, or CT imaging.

Results

Ninety-six patients met inclusion criteria. The mean hernia width was 26 ± 8 cm. The majority (93%) were incisional hernias and 71% were recurrent with 21% having five prior hernia repairs. Of those eligible for recurrence and QoL analysis, 54 (70%) had data points available. HerQLes scores showed a steady improvement throughout postoperative recovery (26 ± 21 at baseline, 44 ± 26 at 30-day follow-up, and 60 ± 33 at 6 months–3 years; P < 0.001), as did the PROMIS Pain Intensity 3a scores (46 ± 11 at baseline, 45 ± 11 at 30-day follow-up, and 39 ± 11 at 6 months–3 years; P = 0.001). At a mean follow-up of 20 ± 10 months, a composite recurrence of 46% was reported, primarily from patients reporting a “bulge” at the site.

Conclusion

Performing a bridged TAR repair with synthetic mesh in patients with complex hernias is associated with high rates of patient-reported bulge perception. Despite this, there was a significant improvement in quality-of-life metrics. When counseling these patients during preoperative evaluation, the results of our study should be shared in candor to aid in informed decision-making.

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Funding

This research received no specific grant or financial support from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, 100, Cleveland, OH, 44195, USA

    H. Alkhatib, L. Tastaldi, D. M. Krpata, C. C. Petro, A. Fafaj, S. Rosenblatt, M. J. Rosen & A. S. Prabhu

Authors
  1. H. Alkhatib
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  2. L. Tastaldi
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  3. D. M. Krpata
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  4. C. C. Petro
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  5. A. Fafaj
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  6. S. Rosenblatt
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  7. M. J. Rosen
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  8. A. S. Prabhu
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Corresponding author

Correspondence to H. Alkhatib.

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Conflicts of interest

Dr. Ajita S. Prabhu reports grants from Intuitive Surgical Inc., personal fees from Intuitive Surgical Inc., and personal fees from Medtronic, outside the submitted work. Dr. Michael J. Rosen receives salary support for his position in the leadership of the Americas Hernia Society Quality Collaborative (AHSQC), which is the data source for the present submission. Other unrelated conflicts of interest outside of the submitted work include grants from Intuitive Surgical Inc., grants from Pacira Pharmaceuticals Inc., board member support and stock options from Ariste Medical. Dr. David M. Krpata reports grants from W.L Gore, outside the submitted work. Dr. Luciano Tastaldi reports grants from Americas Hernia Society Quality Collaborative, outside the submitted work. Dr. Aldo Fafaj reports grants from Americas Hernia Society Quality Collaborative, outside the submitted work. Drs. Steven Rosenblatt, Hemasat Alkhatib, and Clayton Petro report no conflicts of interest.

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This study did not need approval from the local ethical committee.

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This study does not contain any studies with participants or animals performed by any of the authors.

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Alkhatib, H., Tastaldi, L., Krpata, D.M. et al. Outcomes of transversus abdominis release (TAR) with permanent synthetic retromuscular reinforcement for bridged repairs in massive ventral hernias: a retrospective review. Hernia 24, 341–352 (2020). https://doi.org/10.1007/s10029-019-02046-z

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  • DOI: https://doi.org/10.1007/s10029-019-02046-z

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