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Outcomes of transversus abdominis release in non-elective incisional hernia repair: a retrospective review of the Americas Hernia Society Quality Collaborative (AHSQC)

  • H. AlkhatibEmail author
  • L. Tastaldi
  • D. M. Krpata
  • C. C. Petro
  • M. Olson
  • S. Rosenblatt
  • M. J. Rosen
  • A. S. Prabhu
Original Article



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.


Transversus 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.

Ethical approval

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.

Informed consent

For this type of study, formal consent was not required.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Comprehensive Hernia Center, Digestive Disease and Surgery InstituteThe Cleveland Clinic FoundationClevelandUSA
  2. 2.Department of BiostatisticsVanderbilt University Medical CenterNashvilleUSA

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