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Surgical “error traps” of open posterior component separation—transversus abdominis release

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Abstract

Purpose

Past techniques for the repair of complex incisional hernias have been met with unacceptably high recurrence rates and postoperative complications. The transversus abdominis release (TAR) is a versatile and durable solution gaining popularity amongst both abdominal wall specialists and general surgeons. However, several preoperative factors and specific intraoperative pitfalls can have a major impact on patient outcomes.

Methods

The authors review the current literature and draw upon their own practice experience to highlight key preoperative and perioperative steps for avoiding common pitfalls or “error traps” often performed by a surgeon new to this surgical technique.

Results

We discuss preoperative factors that influence the outcomes of patients undergoing incisional hernia repair. We show how a TAR that preserves the neurovascular bundles supplying the rectus complex and dissection in the correct plane prevents the formation of new, challenging unintended hernia defects and provides for wide prosthetic overlap offering the patient a sustainable repair. Lastly, we highlight key postoperative factors that affect a patient’s recovery.

Conclusions

Avoidance of surgical error traps combined with technique mastery can lead to the successful repair of challenging abdominal wall defects using the TAR approach.

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Acknowledgements

The authors have no additional acknowledgements.

Funding

No funding was used for this study.

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Authors and Affiliations

  1. Department of Surgery, Washington University, Saint Louis, MO, USA

    B. Kushner, S. Holden & J. Blatnik

  2. Department of Minimally Invasive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA

    B. Kushner

Authors
  1. B. Kushner
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  2. S. Holden
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  3. J. Blatnik
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Correspondence to B. Kushner.

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Conflict of interest

Dr. Blatnik has an honorary speaking and teaching appointment with Bard International (BD) and Intuitive Surgical. The other authors have no conflicts to report.

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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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Kushner, B., Holden, S. & Blatnik, J. Surgical “error traps” of open posterior component separation—transversus abdominis release. Hernia 25, 1703–1714 (2021). https://doi.org/10.1007/s10029-020-02321-4

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  • DOI: https://doi.org/10.1007/s10029-020-02321-4

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