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Systematic review of transversus abdominis release in complex abdominal wall reconstruction

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Abstract

Background

Transversus abdominis release (TAR), as a type of posterior component separation, is a new myofascial release technique in complex ventral hernia repair. TAR preserves rectus muscle innervation, creates an immense retromuscular plane and allows bilaminar ingrowth of the mesh. The place of the TAR within the range of established anterior component separation techniques (CST) is unclear. Aim of this systematic literature review is to estimate the position of the TAR in the scope of ventral hernia repair techniques.

Methods

MEDLINE, Embase, Pubmed and the Cochrane controlled trials register and Science citation index were searched using the following terms: ‘posterior component separation’, ‘transversus abdominis release’, ‘ventral hernia repair’, ‘complex abdominal wall reconstruction’. To prevent duplication bias, only studies with a unique cohort of patients who underwent transversus abdominis release for complex abdominal wall reconstruction were eligible. Postoperative complications and recurrences had to be registered adequately. The rate of surgical site occurrences and recurrences of the TAR were compared with those after anterior CST, published earlier in two meta-analyses.

Results

Five articles met our strict inclusion criteria, describing 646 TAR patients. Methodological quality per study was good. Mean hernia surface was 509 cm2 and 88% of the hernias were located in the midline. Preoperative risk stratification was distributed in low risk (10%), co-morbid (55%), potentially contaminated (32%) and infected (3%). Pooled calculations demonstrated a mean SSO rate of 15% after TAR (20–35% after anterior CST) and a mean 2-year hernia recurrence rate of 4% (13% after anterior CST). Mean hernia surface was 300 cm2 in anterior component separation studies.

Conclusion

This review demonstrates that the transversus abdominis release is a good alternative for anterior CST in terms of SSO and recurrence, especially in very large midline ventral hernias.

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Author information

Authors and Affiliations

  1. Department of Surgery, Elkerliek Hospital, Helmond, The Netherlands

    J. A. Wegdam, J. M. M. Thoolen & T. S. de Vries Reilingh

  2. Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands

    S. W. Nienhuijs

  3. Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands

    N. de Bouvy

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  1. J. A. Wegdam
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  2. J. M. M. Thoolen
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  3. S. W. Nienhuijs
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  4. N. de Bouvy
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  5. T. S. de Vries Reilingh
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Contributions

JAW and JMMT are both first authors, ex aequo. Study conception and design: JMMT, JAW. Acquisition of data: JMMT, JAW. Analysis and interpretation of data: JMMT, JAW. Drafting of manuscript: JMMT, JAW, TSV-R. Critical revision: TSV-R, SWN, NB.

Corresponding author

Correspondence to J. M. M. Thoolen.

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Conflict of interest

JT, JW, TdVR, SN, NdB declare no conflict of interest.

Ethical approval

This study was reviewed and approved by the Elkerliek Hospital Institutional Review Board.

Human and animal rights

This article does not contain studies directly involving human participants, as it is a review of data already collected and published in previously performed studies.

Informed consent

For this type of study, formal consent was not necessary.

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Wegdam, J.A., Thoolen, J.M.M., Nienhuijs, S.W. et al. Systematic review of transversus abdominis release in complex abdominal wall reconstruction. Hernia 23, 5–15 (2019). https://doi.org/10.1007/s10029-018-1870-5

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  • DOI: https://doi.org/10.1007/s10029-018-1870-5

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