Outcomes of transversus abdominis release in non-elective incisional hernia repair: a retrospective review of the Americas Hernia Society Quality Collaborative (AHSQC)
Elective repair of large incisional hernias using posterior component separation with transversus abdominis release (TAR) has acceptable wound morbidity and long-term recurrence rates. The outcomes of using this reconstructive technique in the non-elective setting remains unknown. We aim to report 30-day outcomes of TAR in non-elective settings.
All patients undergoing open TAR in non-elective settings were identified within the Americas Hernia Society Quality Collaborative (AHSQC). A retrospective review was conducted and outcomes of interest were 30-day Surgical Site Infections (SSI), Surgical Site Occurrences (SSO), SSOs requiring procedural intervention (SSOPI), medical complications, and unplanned readmissions and reoperations.
Fifty-nine patients met inclusion criteria. Mean BMI was 36.6 ± 8.9 kg/m2 and mean hernia width was 14.4 ± 7.2 cm. Forty (67.8%) were recurrent hernias. Pain (88%) and bowel obstruction (79.7%) were the most frequent indications for surgery. Surgical field was classified as clean in 69.5% of cases, with an 88% use of permanent synthetic mesh and fascial closure achieved in 93.2% of cases. There were 15 (25.4%) total wound events, 8 (13.6%) were SSIs. There were 8 (13.6%) SSOPIs, 6 of which were wound opening, 1 wound debridement, and 1 percutaneous drainage. At least one wound or medical complication was reported for 37% of the patients. There were no mortalities.
Not surprisingly, TAR in the non-elective setting is associated with increased wound morbidity requiring procedural interventions and reoperations compared to what has previously been reported for elective cases. The long-term consequences of this wound morbidity with regard to hernia recurrence are as of yet unknown.
KeywordsTransversus abdominis release Emergent Incisional hernia repair Emergency
Compliance with ethical standards
Conflict of interest
Author ASP reports grants from Intuitive Surgical, Inc., personal fees from MedTronic, personal fees from Bard Davol, outside the submitted work. Author MJR reports receiving salary support for role as medical director of nonprofit AHSQC, grants from Intuitive Surgical Inc., Pacira, and Miromatrix, outside the submitted work. Author LT reports grants from Americas Hernia Society Quality Collaborative (AHSQC), outside the submitted work. Author MO reports that the AHSQC has contracted with Vanderbilt University Department of Biostatistics to provide support for AHSQC projects. The work provided for this publication was performed under the umbrella of the Vanderbilt Biostatistics and AHSQC collaboration plan from Vanderbilt University Medical Center, during the conduct of the study. Authors HA, DMK, CCP, SR declare that they have no conflict of interest.
This study did not need approval from the local ethical committee.
Human and animal rights
This study does not contain any studies with participants or animals performed by any of the authors.
For this type of study, formal consent was not required.
- 1.Wolf LL, Scott JW, Zogg CK, Havens JM, Schneider EB, Smink DS, Salim A, Haider AH (2016) Predictors of emergency ventral hernia repair: targets to improve patient access and guide patient selection for elective repair. Surgery 160(5):1379–1391. https://doi.org/10.1016/j.surg.2016.06.027 CrossRefGoogle Scholar
- 3.Altom LK, Snyder CW, Gray SH, Graham LA, Vick CC, Hawn MT (2011) Outcomes of emergent incisional hernia repair. Am Surg 77(8):971–976Google Scholar
- 5.Novitsky YW, Fayezizadeh M, Majumder A, Neupane R, Elliott HL, Orenstein SB (2016) Outcomes of posterior component separation with transversus abdominis muscle release and synthetic mesh sublay reinforcement. Ann Surg 264(2):226–232. https://doi.org/10.1097/SLA.0000000000001673 CrossRefGoogle Scholar
- 7.Petro CC, Como JJ, Yee S, Prabhu AS, Novitsky YW, Rosen MJ (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(2):422–429. https://doi.org/10.1097/TA.0000000000000495 CrossRefGoogle Scholar
- 9.Pauli EM, Wang J, Petro CC, Juza RM, Novitsky YW, Rosen MJ (2015) Posterior component separation with transversus abdominis release successfully addresses recurrent ventral hernias following anterior component separation. Hernia 19(2):285–291. https://doi.org/10.1007/s10029-014-1331-8 CrossRefGoogle Scholar
- 10.Jones CM, Winder JS, Potochny JD, Pauli EM (2016) Posterior component separation with transversus abdominis release: technique, utility, and outcomes in complex abdominal wall reconstruction. Plast Reconstr Surg 137(2):636–646. https://doi.org/10.1097/01.prs.0000475778.45783.e2 CrossRefGoogle Scholar
- 11.Krpata DM, Stein SL, Eston M, Ermlich B, Blatnik JA, Novitsky YW, Rosen MJ (2013) Outcomes of simultaneous large complex abdominal wall reconstruction and enterocutaneous fistula takedown. Am J Surg 205(3):354–358. https://doi.org/10.1016/j.amjsurg.2012.10.013 (discussion 358–359) CrossRefGoogle Scholar
- 15.Poulose BK, Roll S, Murphy JW, Matthews BD, Todd Heniford B, Voeller G, Hope WW, Goldblatt MI, Adrales GL, Rosen MJ (2016) Design and implementation of the Americas Hernia Society Quality Collaborative (AHSQC): improving value in hernia care. Hernia 20(2):177–189. https://doi.org/10.1007/s10029-016-1477-7 CrossRefGoogle Scholar
- 16.American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) (2015) User guide for the 2014 ACS NSQIP participant use data file (PUF). https://www.facs.org/~/media/files/quality%20programs/nsqip/nsqip_puf_userguide_2014.ashx. Accessed 26 Nov 2018
- 18.Surgical site infection (SSI) event [Centers for Disease Control and Prevention web site] (2018) https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf. Accessed 5 Apr 2018
- 19.Liang MK, Holihan JL, Itani K, Alawadi ZM, Gonzalez JR, Askenasy EP, Ballecer C, Chong HS, Goldblatt MI, Greenberg JA, Harvin JA, Keith JN, Martindale RG, Orenstein S, Richmond B, Roth JS, Szotek P, Towfigh S, Tsuda S, Vaziri K, Berger DH (2017) Ventral hernia management: expert consensus guided by systematic review. Ann Surg 265(1):80–89. https://doi.org/10.1097/SLA.0000000000001701 CrossRefGoogle Scholar
- 21.Breuing K, Butler CE, Ferzoco S, Franz M, Hultman CS, Kilbridge JF, Rosen M, Silverman RP, Vargo D (2010) Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 148(3):544–558. https://doi.org/10.1016/j.surg.2010.01.008 CrossRefGoogle Scholar
- 26.Giger UF, Michel JM, Opitz I, Inderbitzin DT, Kocher T, Krähenbühl L (2006) Risk factors for perioperative complications in patients undergoing laparoscopic cholecystectomy: analysis of 22,953 consecutive cases from the Swiss association of laparoscopic and thoracoscopic surgery database. J Am Coll Surg 203(5):723–728. https://doi.org/10.1016/j.jamcollsurg.2006.07.018 CrossRefGoogle Scholar