Transversus Abdominis Release In Patients With Previously Recurrent Ventral Hernias: A Single Institution Experience
*Britta Jean Han, *Bradley Kushner, *Arnab Majumder, *Sara E. Holden, *Jeffrey A. Blatnik
Washington University in Saint Louis, Saint Louis, MO
OBJECTIVE(S): Recurrent hernias pose significant challenges to hernia surgeons. Native anatomic planes are often violated with mesh placement, which can make reoperation technically challenging. Transversus abdominis release (TAR) has been widely utilized for complex hernias and in various challenging populations. The retro-muscular and lateral preperitoneal planes often remain minimally violated despite multiple repairs and can provide a space for novel dissection and mesh placement. This study presents our institutionís experience with open and robotic TAR (O-TAR, R-TAR) in patients with recurrent complex ventral hernias.
METHODS: We conducted a retrospective chart review of patients with recurrent ventral hernias who underwent O-TAR or R-TAR by two fellowship-trained abdominal wall surgeons at a quaternary academic institution from 1/2018 to 9/2020. Exclusion criteria included combined procedures (i.e., gynecological/urological), robotic totally extra-peritoneal (eTEP) or pre-peritoneal repairs, and emergent/urgent cases. Demographic information, peri-operative clinical data, and post-operative follow-up were reviewed.
RESULTS: A total of 133 patients presented with ventral hernia recurrence. Of these, 108 underwent O-TAR and 25 underwent R-TAR. Cohort demographics are presented in Table 1. Seventeen patients underwent staged repair with infected mesh explantation then delayed TAR. Two mesh types were primarily used: Bard soft mesh (63%) and Ethicon Prolene soft mesh (25%) - remaining other meshes are not listed. With mean post-operative follow-up of 6.5 months (range 1 - 30 months), we documented 3 recurrences (2%) (all O-TAR). One recurrence was secondary to mesh midline fracture and underwent repeat O-TAR with different brand mesh without documented re-recurrence. Thirty-four (25.6%) patients had surgical site occurrence and 10 (7.5%) required procedural intervention.
CONCLUSIONS: Our institutionís experience with TAR for patients with recurrent complex ventral hernia suggests O-TAR/R-TAR may provide durable repair for recurrent complex ventral hernias when completed at an experienced center. To our knowledge, we present one of the largest cohorts of recurrent hernia patients undergoing TAR. However, further long term post-operative follow-up is needed to establish extended durability of TAR in these patients.
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