Skip to main content
SpringerLink
Log in

Comparison of open and endoscopic posterior component separation with transversus abdominis release: a propensity score-matched study

  • Original Article
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Background

Posterior component separation with transversus abdominis release (TAR) is considered to be the optimal technique for large incisional ventral hernia repair. Endoscopic TAR (eTAR) that gets all the benefits of minimally invasive surgery (MIS) gives a possibility to enhance results of the treatment. The aim of our study was to make the comparison between open and endoscopic TAR procedures with an emphasis on frequency and severity of postoperative complications in comparable groups.

Materials and methods

All patients had midline incisional hernia and underwent either open (open TAR group) or endoscopic (eTAR group) Rives-Stoppa repair in combination with bilateral transversus abdominis release in Moscow City Hospital №1 from January 2018 to December 2022. A propensity score matching (PSM) was used to make groups comparable. Postoperative complications were classified according to Clavien-Dindo Classification, and Comprehensive complication index was calculated.

Results

We performed 133 open and endoscopic TAR separation for midline incisional hernia. After PSM analysis 51 patients were matched to each group. Overall surgical morbidity in the open TAR group (56.9%) was statistically significantly higher than in the eTAR group (29.4%) (p = 0.009). There were more severe complications (Clavien IIIa-V) in the open TAR group (11.8% vs. 0%, p = 0.027). Length of hospital stay after surgery was shorter in eTAR group (p < 0.001). The Comprehensive complication index in the open TAR group was significantly higher than in eTAR group, 8.7 (0–20.9) vs. 0 (0–8.7) (p = 0.011).

Conclusion

Based on the data from our study, the entire MIS procedure including endoscopic TAR is a safe and optimal technique for surgery of midline incisional ventral hernia, requiring TAR separation in terms of reducing the rate of postoperative complications, their severity and hospital length of stay, compared to open TAR procedure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Malviya A, Patel A, Bhardwaj G, Bulchandani HP, Saini V (2017) A comprehensive study on the incidence and management of incisional hernia. Int Surg J. https://doi.org/10.18203/2349-2902.isj20172786

    Article  Google Scholar 

  2. Rios-Diaz AJ, Morris MP, Christopher AN, Patel V, Broach RB, Heniford BT, Hsu JY, Fischer JP (2022) National epidemiologic trends (2008–2018) in the United States for the incidence and expenditures associated with incisional hernia in relation to abdominal surgery. Hernia 26(5):1355–1368. https://doi.org/10.1007/s10029-022-02644-4

    Article  CAS  PubMed  Google Scholar 

  3. Oprea V, Toma M, Grad O, Bucuri C, Pavel P, Chiorescu S, Moga D (2023) The outcomes of open anterior component separation versus posterior component separation with transversus abdominis release for complex incisional hernias: a systematic review and meta-analysis. Hernia 27(3):503–517. https://doi.org/10.1007/s10029-023-02745-8

    Article  CAS  PubMed  Google Scholar 

  4. Oprea V, Toma M, Grad O, Pavel A, Molnar C (2022) Truncal function after abdominal wall reconstruction via transversus abdominis muscle release (TAR) for large incisional hernias: a prospective case–control study. Hernia. https://doi.org/10.1007/s10029-022-02563-4

    Article  PubMed  Google Scholar 

  5. Haskins IN, Prabhu AS, Jensen KK, Tastaldi L, Krpata DM, Perez AJ, Tu C, Rosenblatt S, Rosen MJ (2019) Effect of transversus abdominis release on core stability: short-term results from a single institution. Surgery 165(2):412–416. https://doi.org/10.1016/j.surg.2018.08.005

    Article  PubMed  Google Scholar 

  6. Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ (2012) Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg 204(5):709–716. https://doi.org/10.1016/j.amjsurg.2012.02.008

    Article  PubMed  Google Scholar 

  7. Belyansky I, Zahiri HR, Park A (2016) Laparoscopic transversus abdominis release, a novel minimally invasive approach to complex abdominal wall reconstruction. Surg Innov 23(2):134–141. https://doi.org/10.1177/1553350615618290

    Article  PubMed  Google Scholar 

  8. Belyansky I, Daes J, Radu VG, Balasubramanian R, Reza Zahiri H, Weltz AS, Sibia US, Park A, Novitsky Y (2018) (eTEP) technique for laparoscopic retromuscular hernia repair. Surg Endosc 32(3):1525–1532. https://doi.org/10.1007/s00464-017-5840-2

    Article  PubMed  Google Scholar 

  9. Burdakov V, Zverev A, Matveev N (2022) Endoscopic transversus abdominis release in the treatment of midline incisional hernias: a prospective single-center observational study on 100 patients. Hernia 26(5):1381–1387. https://doi.org/10.1007/s10029-022-02641-7

    Article  CAS  PubMed  Google Scholar 

  10. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae

    Article  PubMed  PubMed Central  Google Scholar 

  11. Slankamenac K, Graf R, Barkun J, Puhan MA, Clavien PA (2013) The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg 258(1):1–7. https://doi.org/10.1097/SLA.0b013e318296c732

    Article  PubMed  Google Scholar 

  12. Love MW, Warren JA, Davis S et al (2021) Computed tomography imaging in ventral hernia repair: can we predict the need for myofascial release? Hernia 25(2):471–477. https://doi.org/10.1007/s10029-020-02181-y

    Article  CAS  PubMed  Google Scholar 

  13. Bittner R, Bain K, Bansal VK et al (2019) Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS)): Part B. Surg Endosc 33(11):3511–3549

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Balla A, Alarcón I, Morales-Conde S (2020) Minimally invasive component separation technique for large ventral hernia: which is the best choice? A systematic literature review. Surg Endosc 34(1):14–30. https://doi.org/10.1007/s00464-019-07156-4

    Article  PubMed  Google Scholar 

  15. Novitsky YW, Fayezizadeh M, Majumder A, Neupane R, Elliott HL, Orenstein SB (2016) Outcomes of posterior component separation with transversus abdominis muscle release and synthetic mesh sublay reinforcement. Ann Surg 264(2):226–232. https://doi.org/10.1097/SLA.0000000000001673

    Article  PubMed  Google Scholar 

  16. Dewulf M, Hiekkaranta JM, Mäkäräinen E et al (2022) Open versus robotic-assisted laparoscopic posterior component separation in complex abdominal wall repair. BJS Open. https://doi.org/10.1093/bjsopen/zrac057

    Article  PubMed  PubMed Central  Google Scholar 

  17. Bittner JG 4th, Alrefai S, Vy M, Mabe M, Del Prado PAR, Clingempeel NL (2018) Comparative analysis of open and robotic transversus abdominis release for ventral hernia repair. Surg Endosc 32(2):727–734. https://doi.org/10.1007/s00464-017-5729-0

    Article  PubMed  Google Scholar 

  18. Bracale U, Corcione F, Neola D et al (2021) Transversus abdominis release (TAR) for ventral hernia repair: open or robotic? Short-term outcomes from a systematic review with meta-analysis. Hernia 25(6):1471–1480. https://doi.org/10.1007/s10029-021-02487-5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Radu VG, Lica M (2019) The endoscopic retromuscular repair of ventral hernia: the eTEP technique and early results. Hernia 23(5):945–955. https://doi.org/10.1007/s10029-019-01931-x

    Article  CAS  PubMed  Google Scholar 

  20. Wegdam JA, Thoolen JMM, Nienhuijs SW, de Bouvy N, de Vries Reilingh TS (2019) Systematic review of transversus abdominis release in complex abdominal wall reconstruction. Hernia 23(1):5–15. https://doi.org/10.1007/s10029-018-1870-5

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pirogov Russian National Research Medical University, 1, Ostrovityanov Str., Moscow, Russia, 117997

    G. B. Ivakhov, A. A. Kalinina, A. V. Andriyashkin, S. M. Titkova, K. M. Loban, N. S. Glagolev & A. V. Sazhin

Authors
  1. G. B. Ivakhov
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. A. Kalinina
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. V. Andriyashkin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. M. Titkova
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. K. M. Loban
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. N. S. Glagolev
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. V. Sazhin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. B. Ivakhov.

Ethics declarations

Conflict of interest

All authors declare no conflicts of interest.

Ethical approval

The study protocol was approved by Ethical Committee of Pirogov Russian National Research Medical University.

Human and animal rights

Human and animal rights were respected.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ivakhov, G.B., Kalinina, A.A., Andriyashkin, A.V. et al. Comparison of open and endoscopic posterior component separation with transversus abdominis release: a propensity score-matched study. Hernia (2024). https://doi.org/10.1007/s10029-024-02964-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10029-024-02964-7

Keywords

Search

Navigation