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Outcomes of open transverse abdominis release for ventral hernias: a systematic review, meta-analysis and meta-regression of factors affecting them

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Abstract

Objectives

The primary objectives were to evaluate Surgical Site Occurrences (SSO) and Surgical Site Occurrences requiring procedural Intervention (SSOPI) after open transversus abdominis release and to study various factors affecting it. Secondary objectives were to evaluate Surgical Site Infections (SSI), recurrence rates and overall complications after transversus abdominis release (TAR) and the factors responsible for those.

Methods

We searched PUBMED, SCOPUS and Cochrane databases with keywords “transversus abdominis release” or “TAR” OR “Surgical Site Occurrences” OR “posterior component separation AND “outcomes” as per PRISMA 2020 and MOOSE guidelines. Full texts and English literature studies were included, studies mentioning outcomes for open transversus abdominis release for ventral hernia were included and studies with robotic transversus abdominis release were excluded. Percentage occurrences of SSO, SSOPI, SSI, recurrence and overall complications after TAR were evaluated. Random effect meta-analysis with restricted maximum likelihood methods was used for meta-analysis. Heterogeneity was analysed using I2 statistics. Publication bias with eager’s test and funnel plots. Meta0regression analysis was done to evaluate factors affecting the heterogeneity. JASP 0.16.2 software was used for meta-analysis.

Results

Twenty-two studies including 5284 patients who underwent TAR for ventral hernia were included in systematic review and meta-analysis. Overall pooled SSO, SSOPI, Overall Complications, SSI and recurrence rates were 21.72% [95% C.I 17.18–26.27%], 9.82% [95% C.I 7.64 -12%], 33.34% [95% C.I. 27.43–39.26%], 9.13% [95% C.I. 6.41–11.84] and 1.6% [0.78–2.44], respectively. Heterogeneity was significant in all the analysis. Age (p < 0.001), sex (p < 0.001), BMI (p < 0.001),presence of comorbidities (p < 0.001), prior recurrence, defect size (p < 0.001) and current or past history of tobacco exposure were associated with SSO in multivariate meta-regression analysis. Defect size (p = 0.04) was associated with SSOPI. Age (p = 0.011), BMI (p = 0.013), comorbidities (p < 0.01), tobacco exposure (p = 0.018), prior recurrence (p < 0.01) and sex (p < 0.01) were associated with overall complications.

Conclusion

Open transversus abdominis release is associated with high rates of SSO, SSOPI, SSI and overall complications but recurrence rates are low. Various preoperative factors mentioned may be responsible for heterogeneity across studies.

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Abbreviations

SSO:

Surgical site occurrences

SSOPI:

Surgical site occurrences requiring procedural intervention

SSI:

Surgical site infection;

TAR:

Transversus abdominis release

References

  1. Ramirez OM, Ruas MD, Ernesto MD, Dellon A, Lee MD (1990) Components separation method for closure of abdominal-wall defects. Plast Reconstr Surg 86(3):519–526

    Article  CAS  PubMed  Google Scholar 

  2. Wegdam JA, Thoolen JMM, Nienhuijs SW, de Bouvy N, de Vries Reilingh TS (2019) A systematic review of transversus abdominis release in complex abdominal wall reconstruction. Hernia 23(1):5–15

    Article  CAS  PubMed  Google Scholar 

  3. Ventral Hernia Working Group, Breuing K, Butler CE et al (2010) Incisional ventral hernias: a review of the literature and recommendations regarding the grading and technique of repair. Surgery 148(3):544–558

    Article  Google Scholar 

  4. Baucom RB, Ousley J, Oyefule OO et al (2016) Evaluation of long-term surgical site occurrences in ventral hernia repair: implications oa f preoperative site-independent MRSA infection. Hernia 20(5):701–710

    Article  CAS  PubMed  Google Scholar 

  5. Page MJ, McKenzie JE, Bossuyt PM et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71. https://doi.org/10.1136/bmj.n71

    Article  PubMed  PubMed Central  Google Scholar 

  6. Stroup DF, Berlin JA, Morton SC et al (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 283(15):2008–2012

    Article  CAS  PubMed  Google Scholar 

  7. Goossen K, Tenckhoff S, Probst P et al (2018) Optimal literature search for systematic reviews in surgery. Langenbecks Arch Surg 403(1):119–129

    Article  PubMed  Google Scholar 

  8. 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 

  9. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta- analyses. BMJ 327:557–560

    Article  PubMed  PubMed Central  Google Scholar 

  10. Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P: The newcastle-ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta- analyse s. In 2013. http://www.ohri.ca/programs/clinical_ epidemiology/oxfo rd.asp

  11. Oprea V, Radu VG, Moga D (2016) Transversus abdominis muscle release (TAR) for large incisional hernia repair. Chirurgia 111(6):535–540

    Article  PubMed  Google Scholar 

  12. Abdu R, Vasyluk A, Reddy N et al (2021) Hybrid robotic transversus abdominis release versus open: propensity-matched analysis of 30-day outcomes. Hernia 25(6):1491–1497

    Article  CAS  PubMed  Google Scholar 

  13. Gandhi J, Shinde P, Chaudhari S, Banker A, Deshmukh V (2021) Decalogue of transversus abdominis release repair- technical details and lessons learnt. Pol Przegl Chir 93(2):16–25

    Article  PubMed  Google Scholar 

  14. Gala J, Nichat P, Bhandarwar A, Dhimole N, Bhat R, Muley G (2022) Single institute experiences in anterior and posterior component separation technique for the large ventral hernia: a retrospective review. Asian J Surg 45(3):854–859

    Article  PubMed  Google Scholar 

  15. San Miguel-Méndez C, López-Monclús J, Munoz-Rodriguez J et al (2021) Stepwise transversus abdominis muscle release for the treatment of complex bilateral subcostal incisional hernias. Surgery 170(4):1112–1119

    Article  PubMed  Google Scholar 

  16. Han BJ, Kushner BS, Holden SE, Majumder A, Blatnik JA (2022) Transversus abdominis release with posterior component separation in patients with previously recurrent ventral hernias: a single institution experience. Surgery 171(3):806–810

    Article  PubMed  Google Scholar 

  17. Winder JS, Behar BJ, Juza RM, Potochny J, Pauli EM (2016) Transversus abdominis release for abdominal wall reconstruction: early experience with a novel technique. J Am Coll Surg 223(2):271–278

    Article  PubMed  Google Scholar 

  18. Punjani R, Arora E, Mankeshwar R, Gala J (2021) An early experience with transversus abdominis release for complex ventral hernias: a retrospective review of 100 cases. Hernia 25(2):353–364

    Article  CAS  PubMed  Google Scholar 

  19. Kushner BS, Han B, Otegbeye E et al (2021) Chronological age does not predict postoperative outcomes following transversus abdominis release (TAR). Surg Endosc. https://doi.org/10.1007/s00464-021-08734-1

    Article  PubMed  Google Scholar 

  20. Christopher AN, Morris MP, Barrette LX, Patel V, Broach RB, Fischer JP (2021) Longitudinal clinical and patient reported outcomes after transversus abdominis release for complex hernia repair with a review of the literature. Am Surg. https://doi.org/10.1177/00031348211038580

    Article  PubMed  Google Scholar 

  21. Halka JT, Vasyluk A, Demare A, Iacco A, Janczyk R (2019) Hybrid robotic-assisted transversus abdominis release versus open transversus abdominis release: a comparison of short-term outcomes. Hernia 23(1):37–42

    Article  CAS  PubMed  Google Scholar 

  22. Chatzimavroudis G, Kotoreni G, Kostakis I, Voloudakis N, Christoforidis E, Papaziogas B (2021) Outcomes of posterior component separation with transversus abdominis release (TAR) in large and other complex ventral hernias: a singlesurgeon experience. Hernia. https://doi.org/10.1007/s10029-021-02520-7

    Article  PubMed  Google Scholar 

  23. 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(1):43–49

    Article  CAS  PubMed  Google Scholar 

  24. Priya P, Kantharia N, Agrawal JB et al (2020) Short- to midterm results after posterior component separation with transversus abdominis release: initial experience from India. World J Surg 44(10):3341–3348

    Article  PubMed  Google Scholar 

  25. Bittner JG 4th, Alrefai S, Vy M, Mabe M, Del Prado PAR, Clingempeel NL (2018) Comparative analysis of open and robotic transversus abdominis release for ventral hernia repair. Surg Endosc 32(2):727–734

    Article  PubMed  Google Scholar 

  26. Bilezikian JA, Tenzel PL, Faulkner JD, Bilezikian MJ, Powers WF, Hope WW (2021) Comparing the outcomes of external oblique and transverse abdominus release using the AHSQC database. Hernia 25(2):365–373

    Article  CAS  PubMed  Google Scholar 

  27. 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(2):840–845

    Article  PubMed  Google Scholar 

  28. Appleton ND, Anderson KD, Hancock K, Scott MH, Walsh CJ (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(4):265–270

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. 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

    Article  PubMed  Google Scholar 

  30. 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

    Article  CAS  PubMed  Google Scholar 

  31. Krpata DM, Blatnik JA, Novitsky YW, Rosen MJ (2012) Posterior and open anterior components separations: a comparative analysis. Am J Surg 203(3):318–322

    Article  PubMed  Google Scholar 

  32. Baig SJ, Afaque MY, Priya P (2022) Combination of transversus abdominis release and peritoneal flap hernioplasty for large midline ventral hernias: a case series. Indian J Surg. https://doi.org/10.1007/s12262-021-03279-y

    Article  Google Scholar 

  33. Liang MK, Holihan JL, Itani K et al (2017) Ventral hernia management: expert consensus guided by systematic review. Ann Surg 265(1):80–89

    Article  PubMed  Google Scholar 

  34. Zolin SJ, Fafaj A, Krpata DM (2020) Transversus abdominis release (TAR): what are the real indications and where is the limit? Hernia 24(2):333–340

    Article  CAS  PubMed  Google Scholar 

  35. Bracale U, Corcione F, Neola D et al (2021) Transversus abdominis release (TAR) for ventral hernia repair: open or robotic? short-term outcomes from a systematic review with meta-analysis. Hernia 25(6):1471–1480

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Consultant Surgical Gastroenterology, Hepatobiliary and Liver Transplant, Shalby hospitals, Ahmedabad, 380054, India

    Bhavin B. Vasavada & Hardik Patel

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  1. Bhavin B. Vasavada
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Correspondence to Bhavin B. Vasavada.

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Vasavada, B.B., Patel, H. Outcomes of open transverse abdominis release for ventral hernias: a systematic review, meta-analysis and meta-regression of factors affecting them. Hernia 27, 235–244 (2023). https://doi.org/10.1007/s10029-022-02657-z

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