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Laparoscopic transversus abdominis release for complex ventral hernia repair: technique and initial findings

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Abstract

Purpose

The open Rives–Stoppa retrorectus and transversus abdominis release (TAR) techniques are well established in open ventral and incisional hernia repair. The principles are currently being translated into minimally invasive surgery with different concepts. In this study, we investigate our initial results of transperitoneal laparoscopic TAR for ventral incisional hernia repair (laparoscopic TAR).

Methods

Over a 20-month period, 23 consecutive patients with incisional hernias underwent surgery. Laparoscopic TAR was performed transperitoneally with adhesiolysis from the anterior abdominal wall, development of the retrorectus space and TAR, midline reconstruction and extraperitoneal mesh reinforcement.

Results

There were 23 incisional hernias, of which 70% were M2–M4 and 60% were W3. Median patient age was 68 years and the median BMI was 31. Median operating time was 313 min, and hospital stay was 4 days. Morbidity was 26% (Clavien–Dindo 1: n = 4 and 2 + 3b: n = 2).

Conclusion

With the laparoscopic TAR, it was possible to treat a series of patients with ventral incisional hernias. The operating times were long. However, with a low rate of perioperative complications the hospital stay was short As feasibility is demonstrated, the clinical relevance of the method has to be further evaluated.

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Data availability

The data that support the findings of this publication are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Department of Surgery, Vivantes Humboldt Hospital, Academic teaching Hospital of Charité University Medicine, Am Nordgraben 2, 13509, Berlin, Germany

    H. Riediger, L. Kundel, C. Gröger, U. Adam & F. Köckerling

  2. Department of General and Visceral Surgery, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany

    P. Holzner

  3. StatConsult GmbH, Magdeburg, Germany

    D. Adolf

Authors
  1. H. Riediger
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  2. P. Holzner
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  3. L. Kundel
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  4. C. Gröger
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  5. U. Adam
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  6. D. Adolf
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  7. F. Köckerling
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Contributions

HR contributed to the study design, draft preparation, data curation and writing of the paper, PH contributed to the analysis and reviewing of the manuscript, LK contributed to data curation and formal analysis, CG contributed to reviewing this manuscript, UA contributed to the study design, DA contributed to the statistical analysis, FK contributed to study design, statistical analysis, writing and reviewing of the manuscript. All authors read and approved the final paper.

Corresponding author

Correspondence to H. Riediger.

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Conflict of interest

All authors declare that they have no financial or non-financial interests that are directly or indirectly related to the submitted work.

Ethical approval

All authors certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki. All cases were documented in the Herniamed Registry and all patients have signed a special informed consent declaration agreeing to participate. The Herniamed Registry has ethical approval (BASEC No. 2016-00123, 287/2017 B02).

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Riediger, H., Holzner, P., Kundel, L. et al. Laparoscopic transversus abdominis release for complex ventral hernia repair: technique and initial findings. Hernia (2023). https://doi.org/10.1007/s10029-023-02860-6

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