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An early experience with transversus abdominis release for complex ventral hernias: a retrospective review of 100 cases

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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.

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Acknowledgements

No preregistration exists for the reported studies reported in this article.

Funding

No funding was received for this preparation of this manuscript.

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Authors and Affiliations

  1. Fortis Healthcare, Mumbai, India

    R. Punjani

  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

    E. Arora & J. Gala

  3. Department of Preventive and Social Medicine, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, India

    R. Mankeshwar

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All authors certify that they accept responsibility as an author and have contributed to the concept, literature review, manuscript drafting, and give their final approval.

Corresponding author

Correspondence to E. Arora.

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Conflict of interest

Dr. Ramesh Punjani has no conflict of interest or financial ties to disclose. Dr. Eham Arora has received honoraria for speaking engagements from Johnson and Johnson Pvt Ltd, India. Dr. Ranjit Mankeshwar has no conflict of interest or financial ties to disclose. Dr. Jaini Gala has no conflict of interest or financial ties to disclose.

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An internal ethics committee approval was obtained prior to commencing this retrospective study.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Punjani, R., Arora, E., Mankeshwar, R. et al. An early experience with transversus abdominis release for complex ventral hernias: a retrospective review of 100 cases. Hernia 25, 353–364 (2021). https://doi.org/10.1007/s10029-020-02202-w

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