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Transversus abdominis release (TAR): what are the real indications and where is the limit?

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Abstract

Purpose

To review literature surrounding transversus abdominis release (TAR) for incisional hernia repair, with the aim of describing key preoperative and technical considerations for this procedure.

Methods

Existing literature on TAR was reviewed and synthesized with the clinical experience and approach to TAR from a high-volume hernia center.

Results

Recommendations regarding patient selection, optimization and technique for TAR are presented.

Conclusions

While published outcomes of TAR from expert centers are favorable, potentially devastating complications may result when TAR is performed incorrectly or in suboptimal clinical situations. Appropriate patient selection, optimization, and surgeon expertise are necessary if TAR is to be performed.

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References

  1. Krpata DM, Blatnik JA, Novitsky YW, Rosen MJ (2012) Posterior and open anterior components separations: a comparative analysis. Am J Surg 203:318–322. https://doi.org/10.1016/j.amjsurg.2011.10.009

    Article  PubMed  Google Scholar 

  2. Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ (2012) Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg 204:709–716. https://doi.org/10.1016/j.amjsurg.2012.02.008

    Article  PubMed  Google Scholar 

  3. Wegdam JA, Thoolen JMM, Nienhuijs SW, De Bouvy N, de Vries Reilingh TS (2019) Systematic review of transversus abdominis release in complex abdominal wall reconstruction. Hernia 23:5–15. https://doi.org/10.1007/s10029-018-1870-5

    Article  CAS  PubMed  Google Scholar 

  4. Haskins IN, Prabhu AS, Jensen KK et al (2019) Effect of transversus abdominis release on core stability: short-term results from a single institution. Surg (US) 165:412–416. https://doi.org/10.1016/j.surg.2018.08.005

    Article  Google Scholar 

  5. Criss CN, Petro CC, Krpata DM et al (2014) Functional abdominal wall reconstruction improves core physiology and quality-of-life. Surg (US) 156:176–182. https://doi.org/10.1016/j.surg.2014.04.010

    Article  Google Scholar 

  6. Tastaldi L, Blatnik JA, Krpata DM et al (2019) Posterior component separation with transversus abdominis release (TAR) for repair of complex incisional hernias after orthotopic liver transplantation. Hernia 23:363–373. https://doi.org/10.1007/s10029-019-01918-8

    Article  CAS  PubMed  Google Scholar 

  7. Petro CC, Orenstein SB, Criss CN et al (2015) Transversus abdominis muscle release for repair of complex incisional hernias in kidney transplant recipients. Am J Surg 210:334–339. https://doi.org/10.1016/j.amjsurg.2014.08.043

    Article  PubMed  Google Scholar 

  8. Petro CC, Como JJ, Yee S et al (2015) Posterior component separation and transversus abdominis muscle release for complex incisional hernia repair in patients with a history of an open abdomen. J Trauma Acute Care Surg 78:422–429. https://doi.org/10.1097/TA.0000000000000495

    Article  PubMed  Google Scholar 

  9. Pauli EM, Wang J, Petro CC et al (2015) Posterior component separation with transversus abdominis release successfully addresses recurrent ventral hernias following anterior component separation. Hernia 19:285–291. https://doi.org/10.1007/s10029-014-1331-8

    Article  CAS  PubMed  Google Scholar 

  10. Raigani S, Criss CN, Petro CC et al (2014) Single-center experience with parastomal hernia repair using retromuscular mesh placement. J Gastrointest Surg 18:1673–1677. https://doi.org/10.1007/s11605-014-2575-4

    Article  PubMed  Google Scholar 

  11. Alkhatib H, Tastaldi L, Krpata DM et al (2019) Outcomes of transversus abdominis release (TAR) with permanent synthetic retromuscular reinforcement for bridged repairs in massive ventral hernias: a retrospective review. Hernia. https://doi.org/10.1007/s10029-019-02046-z

    Article  PubMed  Google Scholar 

  12. Holihan JL, Nguyen DH, Nguyen MT et al (2016) Mesh location in open ventral hernia repair: a systematic review and network meta-analysis. World J Surg 40:89–99. https://doi.org/10.1007/s00268-015-3252-9

    Article  PubMed  Google Scholar 

  13. Alkhatib H, Tastaldi L, Krpata DM et al (2019) Outcomes of transversus abdominis release in non-elective incisional hernia repair: a retrospective review of the Americas Hernia Society Quality Collaborative (AHSQC). Hernia 23:43–49. https://doi.org/10.1007/s10029-019-01878-z

    Article  CAS  PubMed  Google Scholar 

  14. Krpata DM, Prabhu AS, Tastaldi L et al (2018) Impact of inadvertent enterotomy on short-term outcomes after ventral hernia repair: an AHSQC analysis. Surg (US) 164:327–332. https://doi.org/10.1016/j.surg.2018.04.003

    Article  Google Scholar 

  15. Petro CC, Rosen MJ (2018) Fight or flight: the role of staged approaches to complex abdominal wall reconstruction. Plast Reconstr Surg 142:38S–44S. https://doi.org/10.1097/PRS.0000000000004847

    Article  CAS  PubMed  Google Scholar 

  16. Alkhatib H, Tastaldi L, Krpata DM et al (2019) Impact of modifiable comorbidities on 30-day wound morbidity after open incisional hernia repair. Surg (US) 166:94–101. https://doi.org/10.1016/j.surg.2019.03.011

    Article  Google Scholar 

  17. Petro CC, Haskins IN, Tastaldi L et al (2019) Does active smoking really matter before ventral hernia repair? An AHSQC analysis. Surg (US) 165:406–411. https://doi.org/10.1016/j.surg.2018.07.039

    Article  Google Scholar 

  18. Robin-Lersundi A, Blazquez Hernando L, López-Monclús J et al (2018) How we do it: down to up posterior components separation. Langenbeck’s Arch Surg 403:539–546. https://doi.org/10.1007/s00423-018-1655-4

    Article  Google Scholar 

  19. Colvin J, Rosen M, Prabhu A et al (2019) Enhanced recovery after surgery pathway for patients undergoing abdominal wall reconstruction. Surg (US). https://doi.org/10.1016/j.surg.2019.05.023

    Article  Google Scholar 

  20. Martin-del-Campo LA, Weltz AS, Belyansky I, Novitsky YW (2018) Comparative analysis of perioperative outcomes of robotic versus open transversus abdominis release. Surg Endosc 32:840–845. https://doi.org/10.1007/s00464-017-5752-1

    Article  PubMed  Google Scholar 

  21. Bittner JG, Alrefai S, Vy M et al (2018) Comparative analysis of open and robotic transversus abdominis release for ventral hernia repair. Surg Endosc 32:727–734. https://doi.org/10.1007/s00464-017-5729-0

    Article  PubMed  Google Scholar 

  22. Carbonell AM, Warren JA, Prabhu AS et al (2018) Reducing length of stay using a robotic-assisted approach for retromuscular ventral hernia repair: a comparative analysis from the Americas hernia society quality collaborative. Ann Surg 267:210–217. https://doi.org/10.1097/SLA.0000000000002244

    Article  PubMed  Google Scholar 

  23. Blázquez Hernando LA, López Monclús J, del Valle R, Lersundi A et al (2019) Evaluation of a workshop to teach a new surgical technique in abdominal wall reconstruction. Hernia. https://doi.org/10.1007/s10029-019-02041-4

    Article  PubMed  Google Scholar 

  24. Aquina CT, Kelly KN, Probst CP et al (2014) Surgeon volume plays a significant role in outcomes and cost following open incisional hernia repair. J Gastrointest Surg 19:100–110. https://doi.org/10.1007/s11605-014-2627-9

    Article  PubMed  Google Scholar 

  25. Aquina CT, Fleming FJ, Becerra AZ et al (2017) Explaining variation in ventral and inguinal hernia repair outcomes: a population-based analysis. Surg (US) 162:628–639. https://doi.org/10.1016/j.surg.2017.03.013

    Article  Google Scholar 

  26. Chowdhury MM, Dagash H, Pierro A (2007) A systematic review of the impact of volume of surgery and specialization on patient outcome. Br J Surg 94:145–161. https://doi.org/10.1002/bjs.5714

    Article  CAS  PubMed  Google Scholar 

  27. Sanders DL, Kingsnorth AN, Windsor ACJ (2016) Is there a role for hernia subspecialists? Or is this a step too far? Hernia 20:637–640. https://doi.org/10.1007/s10029-016-1511-9

    Article  CAS  PubMed  Google Scholar 

  28. Parker SG, Reid TH, Boulton R et al (2018) Proposal for a national triage system for the management of ventral hernias. Ann R Coll Surg Engl 100:106–110. https://doi.org/10.1308/rcsann.2017.0158

    Article  CAS  PubMed  Google Scholar 

  29. Gossetti F, D’Amore L, Ceci F et al (2017) Abdominal wall reconstruction (AWR): the need to identify the hospital units and referral centers entitled to perform it. Updates Surg 69:289–290. https://doi.org/10.1007/s13304-017-0428-x

    Article  PubMed  Google Scholar 

  30. Köckerling F, Sheen AJ, Berrevoet F et al (2019) Accreditation and certification requirements for hernia centers and surgeons: the ACCESS project. Hernia 23:185–203. https://doi.org/10.1007/s10029-018-1873-2

    Article  PubMed  PubMed Central  Google Scholar 

  31. Stabilini C, Cavallaro G, Bocchi P et al (2018) Defining the characteristics of certified hernia centers in Italy: the Italian society of hernia and abdominal wall surgery workgroup consensus on systematic reviews of the best available evidences. Int J Surg 54:222–235. https://doi.org/10.1016/j.ijsu.2018.04.052

    Article  PubMed  Google Scholar 

  32. Schlosser KA, Arnold MR, Kao AM et al (2018) Building a multidisciplinary hospital-based abdominal wall reconstruction program: nuts and bolts. Plast Reconstr Surg 142:201S–208S. https://doi.org/10.1097/PRS.0000000000004879

    Article  CAS  PubMed  Google Scholar 

  33. Cottam D, Holover S, Mattar SG et al (2007) The mini-fellowship concept: a six-week focused training program for minimally invasive bariatric surgery. Surg Endosc Other Interv Tech 21:2237–2239. https://doi.org/10.1007/s00464-007-9354-1

    Article  Google Scholar 

  34. Gagnon LH, Abbasi N (2018) Systematic review of randomized controlled trials on the role of coaching in surgery to improve learner outcomes. Am J Surg 216:140–146. https://doi.org/10.1016/j.amjsurg.2017.05.003

    Article  PubMed  Google Scholar 

  35. Poulose BK, Roll S, Murphy JW et al (2016) Design and implementation of the Americas Hernia Society Quality Collaborative (AHSQC): improving value in hernia care. Hernia 20:177–189. https://doi.org/10.1007/s10029-016-1477-7

    Article  CAS  PubMed  Google Scholar 

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Funding

No funding was received for this work.

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Authors and Affiliations

  1. Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A100-133, Cleveland, OH, 44195, USA

    S. J. Zolin, A. Fafaj & D. M. Krpata

Authors
  1. S. J. Zolin
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  2. A. Fafaj
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  3. D. M. Krpata
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Contributions

SJZ performed literature review and manuscript composition. AF assisted with critical revision. DMK assisted with project oversight and critical revision.

Corresponding author

Correspondence to S. J. Zolin.

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Conflict of interest

DK receives an educational grant from W.L. Gore. AF has received the Resident Research Grant from the AHSQC.

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Approval from the institutional review board was not required for this study.

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

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For this retrospective review, formal consent is not required.

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Zolin, S.J., Fafaj, A. & Krpata, D.M. Transversus abdominis release (TAR): what are the real indications and where is the limit?. Hernia 24, 333–340 (2020). https://doi.org/10.1007/s10029-020-02150-5

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  • DOI: https://doi.org/10.1007/s10029-020-02150-5

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