Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction

Abstract Background Several modifications of the classic retromuscular Stoppa technique to facilitate dissection beyond the lateral border of the rectus sheath recently were reported. We describe a novel technique of transversus abdominis muscle release (TAR) for posterior component separation durin...

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Bibliographic Details
Published in:The American journal of surgery 2012-11, Vol.204 (5), p.709-716
Main Authors: Novitsky, Yuri W., M.D, Elliott, Heidi L., M.D, Orenstein, Sean B., M.D, Rosen, Michael J., M.D
Format: Article
Language:English
Subjects:
Abdomen
Abdominal Muscles - surgery
Abdominal wall reconstruction
Asymptomatic
Biological and medical sciences
Body mass index
Component release
Debridement
Dissection
Female
Follow-Up Studies
General aspects
Hernia, Ventral - etiology
Hernia, Ventral - surgery
Hernias
Herniorrhaphy - instrumentation
Herniorrhaphy - methods
Humans
Male
Medical imaging
Medical sciences
Middle Aged
Patients
Posterior component separation
Postoperative Complications - surgery
Recurrence
Reoperation - statistics & numerical data
Retromuscular repair
Retrospective Studies
Sublay
Surgeons
Surgery
Surgical Mesh
Surgical Wound Infection - epidemiology
Surgical Wound Infection - therapy
Sutures
Transversus abdominis muscle
Treatment Outcome
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Summary:Abstract Background Several modifications of the classic retromuscular Stoppa technique to facilitate dissection beyond the lateral border of the rectus sheath recently were reported. We describe a novel technique of transversus abdominis muscle release (TAR) for posterior component separation during major abdominal wall reconstructions. Methods Retrospective review of consecutive patients undergoing TAR. Briefly, the retromuscular space is developed laterally to the edge of the rectus sheath. The posterior rectus sheath is incised 0.5–1 cm underlying medial to the linea semilunaris to expose the medial edge of the transversus abdominis muscle. The muscle then is divided, allowing entrance to the space anterior to the transversalis fascia. The posterior rectus fascia then is advanced medially. The mesh is placed as a sublay and the linea alba is restored ventral to the mesh. Results Between December 2006 and December 2009, we have used this technique successfully in 42 patients with massive ventral defects. Thirty-two (76.2%) patients had recurrent hernias. The average mesh size used was 1,201 ± 820 cm2 (range, 600–2,700). Ten (23.8%) patients developed various wound complications requiring reoperation/debridement in 3 patients. At a median follow-up period of 26.1 months, there have been 2 (4.7%) recurrences. Conclusions Our novel technique for posterior component separation was associated with a low perioperative morbidity and a low recurrence rate. Overall, transversus abdominis muscle release may be an important addition to the armamentarium of surgeons undertaking major abdominal wall reconstructions.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2012.02.008