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Transversus abdominis release with biosynthetic mesh for large ventral hernia repair: a 5-year analysis of clinical outcomes and quality of life

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Abstract

Introduction

Transversus abdominis release (TAR) may provide an optimal plane for mesh placement for large ventral hernias requiring medial myofascial flap advancement. Long-term outcomes of TAR for large ventral hernia repair (VHR) remains under-studied. This study aims to assess longitudinal clinical outcomes and quality of life (QoL) following large VHR with TAR and resorbable biosynthetic mesh.

Methods

Retrospective review of clinical outcomes and prospective QoL was performed for patients undergoing VHR with poly-4-hydroxybutyrate mesh and TAR from 2016 to 2021. Patients with ≤ 24 months of follow-up, defects ≤ 150 cm2, and parastomal hernias were excluded. Cost-related data was collected for each patient’s hospital course. QoL was compared using paired Wilcoxon signed-rank tests.

Results

Twenty-nine patients met inclusion criteria. Median age and BMI were 61 years (53.2–68.1 years) and 31.4 kg/m2 (26.1–35.3 kg/m2). Average hernia defect was 390cm2 ± 152.9 cm2. All patients underwent previous abdominal surgery and were primarily Ventral Hernia Working Group 2 (58.6%). Two hernia recurrences (6.9%) occurred over the median follow-up period of 63.1 months (IQR 43.7–71.3 months), with no cases of mesh infection or explantation. Delayed healing and seroma occurred in 27 and 10.3% of patients, respectively. QoL analysis identified a significant improvement in postoperative QoL (p < 0.005), that continued throughout the 5-year follow-up period, with a 41% overall improvement. Cost analysis identified the hospital revenue generated was approximately equal to the direct costs of patient care. Higher costs were associated with ASA class and length of stay (p < 0.05).

Conclusion

Large VHR with resorbable biosynthetic mesh and TAR can be performed safely, with a low recurrence and complication rate, acceptable hospital costs, and significant improvement in disease-specific QoL at long-term follow-up.

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Data availability

Data is available upon request.

Abbreviations

AHQ:

Abdominal Hernia-Questionnaire

HerQLes:

Hernia-Related Quality of Life Survey

QoL:

Quality of Life

TAR:

Transversus Abdominis Release

VHR:

Ventral Hernia Repair

VHWG:

Ventral Hernia Working Group

CDC:

Center for Disease Control

SSI:

Surgical Site Infection

ACS:

Anterior Component Separation

ASA:

American Society of Anesthesiology

SSO:

Surgical Site Occurrences

PRO:

Patient Reported Outcome

IQR:

Interquartile Range

VH:

Ventral Hernia

EOM:

External Oblique Muscle

REDCap:

Research Electronic Data Capture

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Author notes

  1. C. A. Messa IV and C. Amro contributed equally to this work.

Authors and Affiliations

  1. Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, PCAM South Pavilion 14th Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA

    C. A. Messa IV, C. Amro, E. F. Niu, T. E. Habarth-Morales, A. A. Talwar, S. Thrippleton, R. Broach & J. P. Fischer

  2. St. George’s University School of Medicine, St. George, Grenada

    C. A. Messa IV

  3. Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA

    T. E. Habarth-Morales

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  1. C. A. Messa IV
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Correspondence to J. P. Fischer.

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Conflict of interest

Dr. John Fischer has received consulting payments from 3 M, AbbVie, BD, Baxter, Gore, and Integra Life Sciences. He has received research support from the National. Institutes of Health (NIH). Charles A. Messa IV, Chris Amro, Ellen F. Niu, Theodore E. Habarth-Morales, Ankoor A. Talwar, Sheri Thrippleton, and Robyn Broach have no financial or conflicts of interest or disclosures.

Ethics Approval

This study was performed in line with the principles of the Declaration of Helsinki and approval was granted by the Institutional Review Board at the University of Pennsylvania (Protocol #851883) prior to the conduction of this study.

Human and animal rights'

All procedures were performed with appropriate ethical standards, in accordance with national and institutional human rights standards.

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Due to the retrospective nature of our study, a waiver for informed consent was obtained.

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This paper received the Best Oral Paper Award at the European Hernia Society Meeting 2023 in Sitges, Barcelona, Spain.

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Messa, C.A., Amro, C., Niu, E.F. et al. Transversus abdominis release with biosynthetic mesh for large ventral hernia repair: a 5-year analysis of clinical outcomes and quality of life. Hernia (2023). https://doi.org/10.1007/s10029-023-02889-7

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