Skip to main content

Advertisement

SpringerLink
Log in

Short- to Midterm Results After Posterior Component Separation with Transversus Abdominis Release: Initial Experience from India

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Purpose

Posterior component separation with transversus abdominis release is a new procedure and is quickly gaining popularity. It has shown promising results in terms of low recurrence rates for large and complex hernias. However, there are very little Indian data available on this to date. The purpose of this study was to assess the outcomes of the technique at three centers in India.

Methods

This was a retrospective analysis of the prospectively collected data. Patients with a minimum follow-up of 3 months who underwent open or minimal access posterior component separation were included.

Results

A total of 72 patients (open = 44, minimal access = 25, and hybrid = 3) were included in the analysis. At a follow-up ranging from 3 months to 35 months, there were two recurrences (2.78%). Surgical site occurrences were seen in 23/72 (31.9%), and surgical site infection was seen in 7/72 (9.7%). Surgical site occurrence requiring procedural intervention was 3/72 (4.2%). There were two (2.78%) mortalities in the open group due to myocardial infarction.

Conclusion

Posterior component separation with transversus abdominis release may have advantages in terms of low recurrence in large hernias in the Indian population and can be used in carefully selected patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

ACS:

Anterior component separation

PCS:

Posterior component separation

TA:

Transversus abdominis

IO:

Internal oblique

TAR:

Transversus abdominis release

TF:

Transversalis fascia

BMI:

Body mass index

PRS:

Posterior rectus sheath

RS:

Rives-Stoppa

MIS:

Minimally invasive surgery

POD:

Postoperative day

LOD:

Loss of domain

PDS:

Polydioxanone

VHWG:

Ventral Hernia Working Group

PPP:

Progressive pneumoperitoneum

SSI:

Surgical site infection

SSO:

Surgical site occurrence

SSOPI:

Surgical site occurrence requiring procedural intervention

MI:

Myocardial infarction

References

  1. Holihan JL, Askenasy EP, Greenberg JA et al (2016) Component separation versus bridged repair for large ventral hernias: a multi-institutional risk-adjusted comparison, systematic review, and meta-analysis. Surg Infect (Larchmt) 17:17–26. https://doi.org/10.1089/sur.2015.124

    Article  Google Scholar 

  2. Ramirez OM, Ruas E, Dellon AL (1990) “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 86:519–526

    Article  CAS  PubMed  Google Scholar 

  3. Carbonell AM, Cobb WS, Chen SM (2008) Posterior components separation during retromuscular hernia repair. Hernia 12:359–362. https://doi.org/10.1007/s10029-008-0356-2

    Article  CAS  PubMed  Google Scholar 

  4. 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 

  5. Jones CM, Winder JS, Potochny JD, Pauli EM (2016) Posterior component separation with transversus abdominis release. Plast Reconstr Surg 137:636–646. https://doi.org/10.1097/01.prs.0000475778.45783.e2

    Article  CAS  PubMed  Google Scholar 

  6. Appleton N, Anderson K, Hancock K et al (2017) Initial UK experience with transversus abdominis muscle release for posterior components separation in abdominal wall reconstruction of large or complex ventral hernias: a combined approach by general and plastic surgeons. Ann R Coll Surg Engl 99:265–270. https://doi.org/10.1308/rcsann.2016.0241

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Haskins IN, Prabhu AS, Jensen KK et al (2018) Effect of transversus abdominis release on core stability: short-term results from a single institution. Surgery. https://doi.org/10.1016/j.surg.2018.08.005

    Article  PubMed  Google Scholar 

  8. Halka JT, Vasyluk A, DeMare AM et al (2018) Robotic and hybrid robotic transversus abdominis release may be performed with low length of stay and wound morbidity. Am J Surg 215:462–465. https://doi.org/10.1016/j.amjsurg.2017.10.053

    Article  PubMed  Google Scholar 

  9. Halpern DK, Howell RS, Boinpally H et al (2019) Ascending the learning curve of robotic abdominal wall reconstruction. J Soc Laparoendosc Surg. https://doi.org/10.4293/JSLS.2018.00084

    Article  Google Scholar 

  10. Radu VG, Lica M (2019) The endoscopic retromuscular repair of ventral hernia: the eTEP technique and early results. Hernia 23:945–955. https://doi.org/10.1007/s10029-019-01931-x

    Article  CAS  PubMed  Google Scholar 

  11. Tan WH, McAllister JM, Blatnik JA (2019) Efficacy of robotic versus open transversus abdominis release in a porcine model. Hernia 23:29–35. https://doi.org/10.1007/s10029-018-1836-7

    Article  CAS  PubMed  Google Scholar 

  12. Novitsky YW, Fayezizadeh M, Majumder A et al (2016) Outcomes of posterior component separation with transversus abdominis muscle release and synthetic mesh sublay reinforcement. Ann Surg 264:226–232. https://doi.org/10.1097/SLA.0000000000001673

    Article  PubMed  Google Scholar 

  13. Winder JS, Behar BJ, Juza RM et al (2016) Transversus abdominis release for abdominal wall reconstruction: early experience with a novel technique. J Am Coll Surg 223:271–278. https://doi.org/10.1016/j.jamcollsurg.2016.04.012

    Article  PubMed  Google Scholar 

  14. Gazzola R, Lombardo M, Rosati R, Baruffaldi Preis FW (2016) Posterior component separation with transversus abdominis release. Plast Reconstr Surg 138:562e–563e. https://doi.org/10.1097/PRS.0000000000002453

    Article  CAS  PubMed  Google Scholar 

  15. Oprea V, Gheorghe Radu V, Moga D (2016) Transversus Abdominis Muscle Release (TAR) for large incisional hernia repair. Chirurgia (Bucur) 111:535. https://doi.org/10.21614/chirurgia.111.6.535

    Article  Google Scholar 

  16. Blair LJ, Cox TC, Huntington CR et al (2017) The effect of component separation technique on quality of life (QOL) and surgical outcomes in complex open ventral hernia repair (OVHR). Surg Endosc 31:3539–3546. https://doi.org/10.1007/s00464-016-5382-z

    Article  PubMed  Google Scholar 

  17. Jani K, Contractor S (2019) Retrorectus sublay mesh repair using polypropylene mesh: cost-effective approach for laparoscopic treatment of ventral abdominal wall hernias. J Minim Access Surg 15:287–292. https://doi.org/10.4103/jmas.JMAS_20_19

    Article  PubMed  PubMed Central  Google Scholar 

  18. Espinosa-de-los-Monteros A, Hernandez-Camacho S, Saldivar-Luna A, Rela M (2019) Transversus abdominis release in the treatment of subcostal incisional hernias. J Plast Reconstr Aesthet Surg 72:1700–1738

    Article  PubMed  Google Scholar 

  19. 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 

  20. 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 

  21. 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 

  22. Sanna A, Felicioni L, Cecconi C, Cola R (2019) Retromuscular mesh repair using extended totally extraperitoneal repair minimal access: early outcomes of an evolving technique—a single institution experience. J Laparoendosc Adv Surg Tech lap.2019.0661. https://doi.org/10.1089/lap.2019.0661

  23. Baig S, Priya P (2018) Extended totally extraperitoneal repair (eTEP) for ventral hernias: short-term results from a single centre. J Minim Access Surg. https://doi.org/10.4103/jmas.JMAS_29_18

    Article  Google Scholar 

  24. Belyansky I, Daes J, Radu VG et al (2017) A novel approach using the enhanced-view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair. Surg Endosc. https://doi.org/10.1007/s00464-017-5840-2

    Article  PubMed  Google Scholar 

  25. Nishida C (2004) Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363:157–163

    Article  Google Scholar 

  26. Malhotra KC (1978) Morphological composition of the people of India. J Hum Evol 7:45–53. https://doi.org/10.1016/S0047-2484(78)80035-9

    Article  Google Scholar 

  27. Baig SJ, Priya P (2018) Tailored approach to ventral hernia—our proposed algorithm. Indian J Surg 80:205–206

    Article  PubMed  PubMed Central  Google Scholar 

  28. Tanaka EY, Yoo JH, Rodrigues AJ et al (2010) A computerized tomography scan method for calculating the hernia sac and abdominal cavity volume in complex large incisional hernia with loss of domain. Hernia 14:63–69. https://doi.org/10.1007/s10029-009-0560-8

    Article  CAS  PubMed  Google Scholar 

  29. Novitsky YW (2016) Posterior component separation via transversus abdominis muscle release: the TAR procedure. Hernia surgery. Springer International Publishing, Cham, pp 117–135

    Chapter  Google Scholar 

  30. Breuing K, Butler CE, Ferzoco S et al (2010) Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 148:544–558. https://doi.org/10.1016/j.surg.2010.01.008

    Article  PubMed  Google Scholar 

  31. Halka JT, Vasyluk A, Demare A et al (2019) Hybrid robotic-assisted transversus abdominis release versus open transversus abdominis release: a comparison of short-term outcomes. Hernia 23:37–42. https://doi.org/10.1007/s10029-018-1858-1

    Article  CAS  PubMed  Google Scholar 

  32. 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 

  33. 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 

  34. 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 

  35. Amaral MVFD, Guimarães JR, Volpe P et al (2017) Robotic Transversus Abdominis Release (TAR): Is it possible to offer minimally invasive surgery for abdominal wall complex defects? Rev Col Bras Cir 44:216–219. https://doi.org/10.1590/0100-69912017002009

    Article  PubMed  Google Scholar 

  36. Warren JA, Cobb WS, Ewing JA, Carbonell AM (2017) Standard laparoscopic versus robotic retromuscular ventral hernia repair. Surg Endosc 31:324–332. https://doi.org/10.1007/s00464-016-4975-x

    Article  PubMed  Google Scholar 

  37. Belyansky I, Zahiri HR, Park A (2016) Laparoscopic transversus abdominis release, a novel minimally invasive approach to complex abdominal wall reconstruction. Surg Innov 23:134–141. https://doi.org/10.1177/1553350615618290

    Article  PubMed  Google Scholar 

  38. Cornette B, De Bacquer D, Berrevoet F (2018) Component separation technique for giant incisional hernia: a systematic review. Am J Surg 215:719–726. https://doi.org/10.1016/j.amjsurg.2017.07.032

    Article  PubMed  Google Scholar 

  39. Hodgkinson JD, Leo CA, Maeda Y et al (2018) A meta-analysis comparing open anterior component separation with posterior component separation and transversus abdominis release in the repair of midline ventral hernias. Hernia. https://doi.org/10.1007/s10029-018-1757-5

    Article  PubMed  Google Scholar 

  40. Hauters P, Desmet J, Gherardi D et al (2017) Assessment of predictive factors for recurrence in laparoscopic ventral hernia repair using a bridging technique. Surg Endosc. https://doi.org/10.1007/s00464-016-5401-0

    Article  PubMed  Google Scholar 

  41. Kumar S, Edmunds RW, Dowdy C et al (2018) Anterior versus posterior component separation. Plast Reconstr Surg 142:47S–53S. https://doi.org/10.1097/PRS.0000000000004852

    Article  CAS  PubMed  Google Scholar 

  42. DeBord J, Novitsky Y, Fitzgibbons R et al (2018) SSI, SSO, SSE, SSOPI: the elusive language of complications in hernia surgery. Hernia 22:737–738

    Article  CAS  PubMed  Google Scholar 

  43. Sajid MS, Leaver C, Baig MK, Sains P (2012) Systematic review and meta-analysis of the use of lightweight versus heavyweight mesh in open inguinal hernia repair. Br J Surg 99:29–37. https://doi.org/10.1002/bjs.7718

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

None.

Author information

Author notes

  1. Pallawi Priya and Sarfaraz J. Baig contributed equally.

Authors and Affiliations

  1. Belle Vue Clinic, 9 and 10, Loudon Street, Kolkata, 700046, India

    Pallawi Priya & Sarfaraz J. Baig

  2. Bhatia Hospital, Mumbai, India

    Nimisha Kantharia

  3. Seven Hills Hospital, Mumbai, India

    Jugal B. Agrawal & Abhay Agrawal

  4. MGM Hospital, Mumbai, India

    Laksh Agrawal

  5. J N Medical College, Aligarh Muslim University, Aligarh, India

    Md Yusuf Afaque & Amjad Syed Ali Rizvi

Authors
  1. Pallawi Priya
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nimisha Kantharia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jugal B. Agrawal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Abhay Agrawal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Laksh Agrawal
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Md Yusuf Afaque
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Amjad Syed Ali Rizvi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sarfaraz J. Baig
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

PP and SJB conceived the idea for the topic. PP and SJB initiated the research. NK collected and organized the data. PP, NK and SJB wrote the manuscript. JBA, AA, LAA, MYA and SAAR contributed to the data and edited and wrote parts of the manuscript. SJB and PP contributed equally to the manuscript. All authors participated in the discussions on the topic. All authors have seen the final version and approved it.

Corresponding author

Correspondence to Pallawi Priya.

Ethics declarations

Conflict of interest

PP, NK, JBA, AA, LAA, MYA, SAAR and SJB have no conflicts of interest to declare.

Ethical committee approval

Requirement for Ethical committee clearance was waived for this study.

Written informed consent

All patients gave written informed consent including the consent for collection of data and its use in any subsequent publication before the surgery. A separate consent before publication was not sought as no information in the manuscript reveals patient identity.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Priya, P., Kantharia, N., Agrawal, J.B. et al. Short- to Midterm Results After Posterior Component Separation with Transversus Abdominis Release: Initial Experience from India. World J Surg 44, 3341–3348 (2020). https://doi.org/10.1007/s00268-020-05644-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-020-05644-6

Search

Navigation