Large Incisional Hernia Repair: Abdominal Wall Component Separation & Transversus Abdominis Release

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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P005 POSTERIOR COMPONENT SEPARATION WITH TRANSVERSUS ABDOMINIS RELEASE FOR COMPLEX VENTRAL HERNIA REPAIR: A CASE SERIES

British Journal of Surgery ◽

10.1093/bjs/znab395.004 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Camillo Leonardo Bertoglio ◽

Marianna Maspero ◽

Bruno Alampi ◽

Lorenzo Morini ◽

Carmelo Magistro ◽

...

Keyword(s):

Hernia Repair ◽

Abdominal Wall ◽

Component Separation ◽

Transversus Abdominis ◽

Long Term Results ◽

Transversus Abdominis Release ◽

Median Length ◽

Posterior Component Separation ◽

Short And Long Term

Abstract Aim To assess the short- and long-term outcomes of posterior component separation with transversus abdominis release (PCS-TAR) at our Centre. Material and methods From 2016, our abdominal wall unit started with PCS-TAR for the treatment of patients with complex abdominal wall hernias. We report our prospectively collected preliminary results. Results Sixty-six patients underwent PCS-TAR. Twenty patients had already received at least one previous hernia repair, 16 with mesh implantation. The median width of the defect was 12 cm (range 3 - 35), the median length 15 (range 4 - 40). Defects were multiple in 13 cases, swiss cheese in 2 cases. Eleven defects had both a midline and a lateral component, 3 had a concomitant parastomal hernia. Thirty-eight cases were located near the abdominal wall borders. The median duration of surgery was 255 minutes (range 84 - 740). TAR was partial in 24 cases and monolateral in 24. Twelve cases involved previous mesh removal. Fifty patients received implantation of more than one mesh: the most common combination was a PVDF mesh on top of a biosynthetic mesh. The mesh seldom needed to be fixed. The median length of stay was 6 days (range 3 - 61). Postoperative complications occurred in 22 patients (3 were major). Surgical site occurrences happened in 7 cases. After at least 12 months of follow up per patient, there was 1 recurrence, 1 case of chronic pain and no chronic seromas. Conclusions Posterior component separation with transversus abdominis release offers a versatile solution for a variety of complex ventral hernias, with good short- and long-term results.

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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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