Transversus abdominis release in the management of a large, chronic defect of the abdominal wall
Authors:
P. Ostruszka; P. Ihnát; D. Toman
Authors‘ workplace:
Chirurgická klinika, Fakultní nemocnice Ostrava, Lékařská fakulta Ostravské univerzity
Published in:
Rozhl. Chir., 2022, roč. 101, č. 5, s. 244-249.
Category:
Case Report
doi:
https://doi.org/10.33699/PIS.2022.101.5.244–250
Overview
Introduction: Chronic defects and hernias of the abdominal wall are a common complication of repeated surgical procedures and/or their accompanying complications. Reconstruction of the abdominal wall is difficult in these defects/hernias and debates of an ideal method of treatment have not reached a conclusion. Primary suture is usually impossible. Onlay, inlay, sublay, underlay and IPOM plasty procedures have their limits and often lead to unsatisfactory results. CST (component separation technique) technique is a new therapeutic approach enabling a solution of large defects and hernias of the abdominal wall with very good short-term results. TAR (transversus abdominis release) is a posterior approach in CST. It releases transversus abdominis muscle (MTA) to mobilize the posterior sheath of the rectus abdominis muscle (MRA). TAR preserves MRA and its neurovascular bundle, creates a large space for mesh insertion and allows complex reconstruction of the abdominal wall.
Case report: A 55-year-old patient underwent surgery for perforated diverticulitis of colon sigmoideum with diffuse peritonitis. Hartman’s operation was performed. The patient was reoperated for colostomy necrosis and fascia dehiscence on the 7th postoperative day. After healing 6 months later, colostomy occlusion was indicated. The operation itself – colorectal anastomosis using an end-to-end circular stapler – was without complications. However, complications occurred in the postoperative period including an intra-abdominal abscess in the lesser pelvis and subsequent destructive phlegmona and necrosis of the abdominal wall, resulting in a non-healing extensive chronic abdominal wall defect. After the failure of conservative treatment, the chronic defect was excised and the abdominal wall was reconstructed using the TAR method.
Conclusion: TAR is an acceptable method in the treatment of large defects and hernias of the abdominal wall, associated with low perioperative morbidity and low recurrence rates.
Keywords:
Tar – abdominal wall defect
Sources
1. Shell DH 4th, de la Torre J, Andrades P, et al. Open repair of ventral incisional hernias. Surg Clin North Am. 2008 Feb;88(1):61−83, viii. doi:10.1016/j. suc.2007.10.008. PMID: 18267162.
2. Forbes SS, Eskicioglu C, McLeod RS, et al. Meta-analysis of randomized controlled trials comparing open and laparoscopic ventral and incisional hernia repair with mesh. Br J Surg. 2009 Aug;96(8):851−858. doi:10.1002/bjs.6668. PMID: 19591158.
3. Bittner R, Bingener-Casey J, Dietz U, et al. International Endohernia Society (IEHS). Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS)-part 1. Surg Endosc. 2014 Jan;28(1):2−29. doi:10.1007/s00464- 013-3170-6. Epub 2013 Oct 11. PMID: 24114513; PMCID: PMC3872300.
4. Albanese AR. Las incisiones de descarga en el tratamiento de las grandes eventraciones supraumbilicales. Prensa Med Argent. 1966 Sep 23;53(38):2222−2227.
5. Ramirez OM, Ruas E, Dellon AL. “Components separation“ method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg. 1990 Sep;86(3):519−5126. doi: 10.1097/00006534-199009000-00023. PMID: 2143588.
6. Carbonell AM, Cobb WS, Chen SM. Posterior components separation during retromuscular hernia repair. Hernia 2008 Aug;12(4):359−362. doi:10.1007/s10029- 008-0356-2. Epub 2008 Feb 22. PMID: 18293053.
7. Novitsky YW, Elliott HL, Orenstein SB, et al. Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg. 2012 Nov;204(5):709−716. doi:10.1016/j. amjsurg.2012.02.008. Epub 2012 May 16. PMID: 22607741.
8. Forte A, Zullino A, Manfredelli S, et al. Rives technique is the gold stardard for incisional hernioplasty. An institutional experience. Ann Ital Chir. 2011 Jul– Aug;82(4):313−317. PMID: 21834484.
9. Holihan JL, Nguyen DH, Nguyen MT, et al. Mesh location in open ventral hernia repair: A systematic review and network meta-analysis. World J Surg. 2016 Jan;40(1):89−99. doi:10.1007/s00268- 015-3252-9. PMID: 26423675.
10. Timmermans L, de Goede B, van Dijk SM, et al. Meta-analysis of sublay versus onlay mesh repair in incisional hernia surgery. Am J Surg. 2014 Jun;207(6):980−988. doi:10.1016/j.amjsurg.2013.08.030. Epub 2013 Oct 26. PMID: 24315379.
11. Appleton ND, Anderson KD, Hancock K, et al. Initial UK experience with transversus abdominis muscle release for posterior components separation in abdominal wall reconstruction of large or complex ventral hernias: a combined approach by general and plastic surgeons. Ann R Coll Surg Engl. 2017;99(4):265−270. doi:10.1308/rcsann.2016.0241.
12. Slater NJ, van Goor H, Bleichrodt RP. Large and complex ventral hernia repair using „components separation technique“ without mesh results in a high recurrence rate. Am J Surg. 2015 Jan;209(1):170−179. doi:10.1016/j.amjsurg.2014.02.013. Epub 2014 Apr 28. PMID: 24933669.
13. Scheuerlein H, Thiessen A, Schug-Pass C, et al. What do we know about component separation techniques for abdominal wall hernia repair? Front Surg. 2018 Mar 27;5:24. doi:10.3389/fsurg.2018.00024. PMID: 29637073; PMCID: PMC5881422.
14. Novitsky YW. Posterior component separation via transversus abdominis muscle release: the TAR procedure. In Novitsky YW (editor), Hernia surgery. Current principles. Switzerland, Springer International Publishing 2016:117−136.
15. Krpata DM, Blatnik JA, Novitsky YW, et al. Posterior and open anterior components separations: a comparative analysis. Am J Surg. 2012 Mar;203(3):318−322; discussion 322. doi:10.1016/j.amjsurg. 2011.10.009. Epub 2012 Jan 12. PMID: 22244073.
16. Pauli EM, Rosen MJ. Open ventral hernia repair with component separation. Surg Clin North Am. 2013 Oct;93(5):1111−133. doi:10.1016/j. suc.2013.06.010. Epub 2013 Jul 25. PMID: 24035078.
17. Novitsky YW, Fayezizadeh M, Majumder A, et al. Outcomes of posterior component separation with transversus abdominis muscle release and synthetic mesh sublay reinforcement. Ann Surg. 2016 Aug;264(2):226−232. doi:10.1097/ SLA.0000000000001673. PMID: 26910200.
18. Cornette B, De Bacquer D, Berrevoet F. Component separation technique for giant incisional hernia: A systematic review. Am J Surg. 2018 Apr;215(4):719−726. doi:10.1016/j.amjsurg.2017.07.032. Epub 2017 Aug 10. PMID: 28811004.
19. Nielsen MF, de Beaux A, Tulloh B. Peritoneal flap hernioplasty for reconstruction of large ventral hernias: Long-term outcome in 251 patients. World J Surg. 2019 Sep;43(9):2157−2163. doi:10.1007/ s00268-019-05011-0. PMID: 31065774.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2022 Issue 5
Most read in this issue
- Pectoralis major ruptures
- Endovenous ablation of varicose veins − current status and overview of methods
- Appendicolith as a cause of late complications after appendectomy – a case report and literature review
- Transversus abdominis release in the management of a large, chronic defect of the abdominal wall