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Reverse TAR may be added when necessary in open preperitoneal repair of lateral incisional hernias: a retrospective multicentric cohort study

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Abstract

Background

The best approach for lateral incisional hernia is not known. Posterior component separation (reverse TAR) offers the possibility of using the retromuscular space for medial extension of the challenging preperitoneal plane. The aim of our multicenter study was to compare the operative and patient-reported outcomes measures (PROMs) using two open surgical techniques from the lateral approach: a totally preperitoneal vs a reverse TAR.

Methods

A retrospective cohort study was performed since 2012 to 2020. Patients with lateral incisional hernia treated through a lateral approach were identified from a prospectively maintained multicenter database. Reverse TAR was added when the preperitoneal plane could not be safely dissected. The results obtained using these two lateral approaches were compared, including short- and long-term complications, as well as PROMs, using the specific tool EuraHSQoL.

Results

A total of 61 patients were identified. Reverse TAR was performed in 33 patients and lateral retromuscular preperitoneal approach in 28 patients. Both groups were comparable in terms of sociodemographic and comorbidities variables. Surgical site occurrences occurred in 13 cases (21.3%), with 8 patients (13.1%) requiring procedural intervention. During a median follow-up of 34 months, no incisional hernia recurrence was registered. There was a case (1.6%) of symptomatic bulging that required reoperation. Also 12 patients (19.7%) presented an asymptomatic bulging. No statistically significant difference was identified in the complications and PROMs between the two procedures.

Conclusion

The open lateral retromuscular reconstruction using very large meshes that reach the midline has excellent long-term results with acceptable postoperative complications, including PROMs. A reverse TAR may be added, when necessary, without increasing complications and obtaining similar long-term results.

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Abbreviations

ASA:

American Society of Anesthesiologists

AWR:

Abdominal wall reconstruction

BMI:

Body mass index

CDC:

Centers for Disease Control and Prevention

CeDAR:

Carolina’s equation for determining associated risks

COPD:

Chronic obstructive pulmonary disease

CT:

Computed tomography

DVT:

Deep venous thrombosis

EHS:

European Hernia Society

EuraHSQoL:

European Abdominal Wall Hernia Quality of Life Scores

GEE:

Generalized estimating equations

ICAP:

International Classification of Abdominal Wall Planes

IH:

Incisional hernia

LAW:

Lateral abdominal wall

PCS:

Posterior component separation

PE:

Pulmonary thromboembolism

PROM:

Patient-reported outcomes measure

QoL:

Quality of Life

SPSS:

Statistical Package for the Social Sciences

SSI:

Surgical site infection

SSO:

Surgical site occurrence

SSOPI:

Surgical site occurrence that required procedural intervention

STROB:

Strengthening the Reporting of Observational Studies in Epidemiology

STROCSS:

Strengthening the Reporting of Cohort Studies in Surgery

TAR:

Transversus abdominis release

VHSS:

Ventral hernia staging system

VHWG:

Ventral hernia working group

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Acknowledgements

We thank Dixie Huntley MD for her linguistic assistance during the preparation of this article.

Funding

No funding was received for this article.

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Authors and Affiliations

  1. Puerta de Hierro Majadahonda University Hospital, C. Joaquín Rodrigo, 1, 28222, Majadahonda, Madrid, Spain

    Joaquin M. Munoz-Rodriguez, Javier Lopez-Monclus, Ana Royuela-Vicente & Aritz Equisoain-Azcona

  2. Autónoma de Madrid University, Madrid, Spain

    Joaquin M. Munoz-Rodriguez, Javier Lopez-Monclus, Ana Royuela-Vicente & Aritz Equisoain-Azcona

  3. Henares University Hospital, Av. de Marie Curie, 0, 28822, Coslada, Madrid, Spain

    Marina Perez-Flecha, Alvaro Robin-Valle de Lersundi, Manuel Medina-Pedrique & Miguel A. Garcia-Urena

  4. Complex Abdominal Wall Research Group From Francisco de Vitoria University, Madrid, Spain

    Marina Perez-Flecha, Alvaro Robin-Valle de Lersundi, Manuel Medina-Pedrique & Miguel A. Garcia-Urena

  5. Ramón y Cajal University Hospital, M-607, 9, 100, 28034, Madrid, Spain

    Luis A. Blazquez-Hernando

  6. Alcala de Henares University, Campus Universitario-C/ 19, Av. de Madrid, Km 33,600, 28871, Alcalá de Henares, Madrid, Spain

    Juan P. Garcia-Hernandez

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  1. Joaquin M. Munoz-Rodriguez
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Contributions

JMMR, JLM, MPF, ARVDL, LABH, AR, JPGH, AEA, MMP, and MAGU have participated in the preparation of the article by meeting the following criteria: Authors make substantial contributions to conception and design, and/or acquisition of data, and/or analysis and interpretation of data; Authors participate in drafting the article or revising it critically for important intellectual content; Authors give final approval of the version to be submitted and any revised version to be published.

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Correspondence to Javier Lopez-Monclus.

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Disclosures

Joaquin M. Munoz-Rodriguez receives speaker fee from Braun and WL Gore & Associates. Javier Lopez-Monclus having receives speaker fees from Medtronic, Dipromed and WL Gore & Associates. Alvaro Robin Valle De Lersundi receives speaker fee from WL Gore & Associates. Luis A. Blazquez-Hernando receives speaker fees from Dipromed and WL Gore & Associates.Miguel A. Garcia-Urena received speaker fees from Medtronic, Bard, Dipromed, Dynamesh, Braun, Johnson and Johnson, Telabio and WL Gore & Associates and Medtronic. Marina Perez-Flecha, Ana Royuela, Juan P. Garcia-Hernandez, Aritz Equisoain Azcona, Manuel Medina Pedrique have no conflicts of interest or financial ties to disclose.

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Supplementary Information

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Supplementary file1 (MP4 140870 kb) Video 1: Lateral retromuscular preperitoneal technique. Video clip showing the stepwise preperitoneal retromuscular lateral surgical technique

Supplementary file2 (MP4 148937 kb) Video 2: Reverse TAR technique. Video clip showing the stepwise reverse TAR surgical technique

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Munoz-Rodriguez, J.M., Lopez-Monclus, J., Perez-Flecha, M. et al. Reverse TAR may be added when necessary in open preperitoneal repair of lateral incisional hernias: a retrospective multicentric cohort study. Surg Endosc 36, 9072–9091 (2022). https://doi.org/10.1007/s00464-022-09375-8

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