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Long-term outcomes and quality of life assessment after posterior component separation with transversus abdominis muscle release (TAR)

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Abstract

Background

Although transversus abdominis release (TAR) to treat large incisional hernias has shown favorable postoperative outcomes, devastating complications may occur when it is used in suboptimal conditions. We aimed to evaluate postoperative outcomes and long-term follow-up after TAR for large incisional hernias.

Methods

A consecutive series of patients undergoing TAR for complex incisional hernias between 2014 and 2019 with a minimum of 6 month follow-up was included. Demographics, operative and postoperative variables were analyzed. Postoperative imaging (CT-scan) was also evaluated to detect occult recurrences. The HerQLes survey for quality of life (QoL) assessment was performed preoperatively and 6 months after the surgery.

Results

A total of 50 TAR repairs were performed. Mean age was 65 (35–83) years, BMI was 28.5 ± 3.4 kg/m2, and 8 (16%) patients had diabetes. Mean Tanaka index was 14.2 ± 8.5. Mean defect area was 420 (100–720) cm2, average defect width was 19 ± 6.2 cm, and mesh area was 900 (500–1050) cm2; 78% were clean procedures, and in 60% a panniculectomy was associated. Operative time was 252 (162–438) minutes, and hospital stay was 4.5 (2–16) days. Thirty-day morbidity was 24% (12 patients), and 16% (8 patients) had surgical site infections. Overall recurrence rate was 4% (2 patients) after 28.2 ± 20.1 months of follow-up. QoL showed a significant improvement after surgery (p = 0.001).

Conclusions

The TAR technique is an effective treatment modality for large incisional hernias, showing an acceptable postoperative morbidity, a significant improvement in QoL, and low recurrence rates at long-term follow-up.

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Authors and Affiliations

  1. Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredón 1640, CP 1118, Buenos Aires, Argentina

    E. E. Sadava, M. E. Peña, C. Bras Harriott, M. A. Casas, F. Schlottmann & F. Laxague

  2. Division of Abdominal Wall Surgery, Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina

    E. E. Sadava

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  1. E. E. Sadava
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  2. M. E. Peña
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  3. C. Bras Harriott
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  4. M. A. Casas
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  5. F. Schlottmann
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  6. F. Laxague
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Contributions

EES writing-original draft preparation, visualization, supervision, project administration. MEP data curation, visualization, investigation, formal analysis. CBH investigation, resources. MAC investigation, resources. FS writing-original draft preparation, visualization, supervision. FL conceptualization, methodology, writing- original draft preparation.

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Correspondence to E. E. Sadava.

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Disclosures

Emmanuel Ezequiel Sadava, Maria Elena Peña, Camila Bras Harriott, Maria Agustina Casas, Francisco Schlottmann and Francisco Laxague have no conflicts of interest or financial ties to disclose.

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Presented at American Hernia Society Annual Meeting, September 2020.

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Sadava, E.E., Peña, M.E., Bras Harriott, C. et al. Long-term outcomes and quality of life assessment after posterior component separation with transversus abdominis muscle release (TAR). Surg Endosc 36, 1278–1283 (2022). https://doi.org/10.1007/s00464-021-08402-4

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