BACKGROUND: In ventral hernia repair, closure of the defect is one of the most significant challenges, especially in a wide defect, large hernias with loss of domain, and recurrent hernias. Posterior component separation with transverses abdominis muscle release (TAR) is a novel approach that offers a solution for complex ventral hernias.
AIMS AND OBJECTIVES: To assess the clinical effectiveness of posterior abdominal wall components separation with transversus abdominis muscle release (PCS-TAR) in the management of ventral abdominal hernia with loss of domain.
METHOD: The posterior component separation by transversus abdominis muscle release (simply TAR) is a modification of the Rives-Stoppa procedure which combines it with developing of a large retro-muscular/pre-peritoneal plane and a consistent medial advancement of the abdominal wall musculature and accompanying fascia. This preserves the neurovascular bundles innervating the medial abdominal wall. Mesh is placed in a sublay fashion above the posterior layer. In an overwhelming majority of patients, the linea alba is reconstructed, creating a functional abdominal wall with wide mesh reinforcement.
RESULT: We used this procedure in a case of large median ventral incisional hernia. Our patient was a known post-operative case of exploratory laparotomy for ileal perforation following blunt abdominal trauma. Ileostomy was done due to gross intraperitoneal contamination. His post-operative recovery was complicated by wound dehiscence previously. Patient presented with a hernia along the midline wound with a gap of 12*7 cm. After the abdominal wall reconstruction procedure (TAR) with mesh placement over posterior rectus sheath (15*20cm) his post op recovery was uneventful. There was no recurrence till follow up of 3 months.
CONCLUSION: TAR seems to be the effective approach for complex hernias with good immediate outcomes.
ABDOMINAL WALL RECONSTRUCTION BY BILATERAL TRANSVERSUS ABDOMINIS RELEASE – A MASTERLY PROCEDURE
