The influence of Transversus Abdominis Muscle Release (TAR) for complex incisional hernia repair on the intraabdominal pressure and pulmonary function

Abstract Aim “COVID has been a great challenge for Hospitals around the world. At our surgical department a new protocol of TAP block was designed and implemented in our laparoscopic incisional ventral hernia repairs, to allow these patients to be operated in ambulatory regime, without compromising pain control and the outcomes. In this video we aim to present the technique for the Laparoscopic-guided TAP Block during a Laparoscopic IPOM Plus ventral hernia repair.” Material and Methods “We implemented this protocol in July 2020 and since then, we performed 18 TAP block in laparoscopic incisional hernia repairs, laparoscopic guided by the Surgeon or ultrasound-guided by the Anesthesiologist. In this case, the video reports to a Laparoscopic IPOM Plus incisional hernia repair performed on a 54-year-old patient, male, with obesity, arterial hypertension and dyslipidemia. He had a 6 centimeter incisional hernia post-colorectal surgery in 2013.” Results “As detailed in the video, we show all the steps to perform a TAP block under laparoscopic direct visualization” Conclusions “TAP block can be performed by the Surgeon, with direct visualization at the beginning of the laparoscopic procedure.”

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Robotic versus open transversus abdominis release and incisional hernia repair: A case-control study

Laparoscopic Endoscopic and Robotic Surgery ◽

10.1016/j.lers.2020.06.002 ◽

2020 ◽

Vol 3 (3) ◽

pp. 59-62

Author(s):

Jenna Reeves ◽

Shreya Mehta ◽

Ramesh Damodaran Prabha ◽

Yasser Salama ◽

Anubhav Mittal

Keyword(s):

Incisional Hernia ◽

Hernia Repair ◽

Case Control Study ◽

Incisional Hernia Repair ◽

Case Control ◽

Transversus Abdominis ◽

Transversus Abdominis Release ◽

Control Study

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P160 ENDOSCOPIC ANTERIOR COMPONENT SEPARATION OR OPEN TRANSVERSUS ABDOMINUS RELEASE ARE NOT ASSOCIATED WITH INCREASED WOUND MORBIDITY FOLLOWING INCISIONAL HERNIA REPAIR

British Journal of Surgery ◽

10.1093/bjs/znab395.149 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Freia Gaspar ◽

Helle Midtgaard ◽

Lars Nannestad Jorgensen ◽

Kristian Kiim Jensen

Keyword(s):

Incisional Hernia ◽

Hernia Repair ◽

Incisional Hernia Repair ◽

Reoperation Rate ◽

Hernia Recurrence ◽

Component Separation ◽

Transversus Abdominis ◽

High Rate ◽

Significant Difference ◽

Anterior Component Separation

Abstract Aim Traditional anterior component separation during incisional hernia repair is associated with a high rate of postoperative wound morbidity. Because extensive subcutaneous dissection is avoided by endoscopic anterior component separation (eACS) or open transversus abdominis release (TAR), we hypothesized that these techniques did not increase the incidence of surgical site occurrence compared to incisional hernia repair without component separation. Material and Methods This was a retrospective cohort study of patients undergoing open, retro-rectus incisional hernia repair. Component separation during retro-rectus repair was performed using eACS or TAR. The primary outcome was 30-day incidence of postoperative surgical site occurrence. Secondary outcomes included length of stay, 30-day readmission, 30-day reoperation rate and 3-year recurrence rate. Results A total of 322 patients underwent retro-rectus repair, 168 (52%) of whom received either eACS or TAR. Addition of eACS or TAR was neither associated with surgical site occurrence, (odds ratio: 0.82, confidence interval: 0.40-1.68, P = 0.596) nor with hernia recurrence (hazard ratio 0.80, CI 0.27-2.40, P = 0.693). There was no significant difference between the groups regarding the frequencies of 30 day-readmission or 30-day reoperation. Conclusions The addition of eACS or TAR to a retro-rectus incisional hernia repair was not associated with increased wound morbidity or hernia recurrence.

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Primary and Recurrent Repair of Incisional Hernia Based on Biomechanical Considerations to Avoid Mesh-Related Complications

Frontiers in Surgery ◽

10.3389/fsurg.2021.764470 ◽

2021 ◽

Vol 8 ◽

Author(s):

Regine Nessel ◽

Thorsten Löffler ◽

Johannes Rinn ◽

Philipp Lösel ◽

Samuel Voss ◽

...

Keyword(s):

Incisional Hernia ◽

Hernia Repair ◽

Abdominal Wall ◽

Recurrent Disease ◽

Incisional Hernia Repair ◽

Recurrent Hernia ◽

Transversus Abdominis ◽

Single Shot ◽

Complication Rates ◽

Tissue Elasticity

Aim: Mechanical principles successfully guide the construction of polymer material composites in engineering. Since the abdominal wall is a polymer composite augmented with a textile during incisional hernia repair we ask: can incisional hernia be repaired safely and durably based on biomechanical principles?Material and Methods: Repair materials were assessed on a self-built bench test using pulse loads to elude influences on the reconstruction of the abdominal wall. Tissue elasticity was analyzed preoperatively as needed with computed tomography at rest and during Valsalva's maneuver. Preoperatively, the critical retention force of the reconstruction to pulse loads was calculated and a biomechanically durable repair was designed based on the needs of the individual patient. Intraoperatively, the design was adjusted as needed. Hernia meshes with high grip factors (Progrip®, Dahlhausen® Cicat) were used for the repairs. Mesh sizes, fixation elements and reconstructive details were oriented on the biomechanical design. All patients recieved single-shot antibiosis. Patients were discharged after full ambulation was achieved.Results: A total of 163 patients (82 males and 81 females) were treated for incisional hernia in four hospitals by ten surgeons. Primary hernia was repaired in 119 patients. Recurrent hernia was operated on in 44 cases. Recurrent hernia was significantly larger (median 161 cm2 vs. 78 cm2; u-test: p = 0.00714). Re-do surgery took significantly longer (median 229 min vs. 150 min; p < 0.00001) since recurrent disease required more often transversus abdominis release (70% vs. 47%). GRIP tended to be higher in recurrent repair (p = 0.01828). Complication rates (15%) and hospital stay were the same (6 vs. 6 days; p = 0.28462). After 1 year, no recurrence was detected in either group. Pain levels were equally low in both primary and recurrent hernia repairs (median NAS = 0 in both groups at rest and under load, p = 0.88866).Conclusion: Incisional hernia can safely and durably be repaired based on biomechanical principles both in primary and recurrent disease. The GRIP concept provides a base for the application of biomechanical principles in incisional hernia repair.

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