AUTHOR=Riediger Hartwig , Köckerling Ferdinand 

TITLE=Limitations of Transversus Abdominis Release (TAR)—Additional Bridging of the Posterior Layer And/Or Anterior Fascia Is the Preferred Solution in Our Clinical Routine If Primary Closure is Not Possible

JOURNAL=Journal of Abdominal Wall Surgery

VOLUME=Volume 3 - 2024

YEAR=2024

URL=https://www.frontierspartnerships.org/journals/journal-of-abdominal-wall-surgery/articles/10.3389/jaws.2024.12780

DOI=10.3389/jaws.2024.12780

ISSN=2813-2092

ABSTRACT=By separa&ng the abdominal wall, transversus abdominis release (TAR) permits reconstruc&on of the abdominal wall and placement of large meshes for many types of hernia. However, in boundary cases the mobility of the layers is inadequate and addi&onal bridging techniques may be required for tension-free closure. We now present our own data on this.In 2023, we performed transversus abdominis release in 50 pa&ents as part of hernia repair. The procedures were carried out in open (n=25), robo&c (n=24), and laparoscopic (n=1) technique. The hernia sac was always integrated into the anterior suture and, in the case of medial hernias, was used for linea alba reconstruc&on.For medial hernia open TAR was performed in 22 cases. Addi&onal posterior bridging was performed in 7 of these cases. The ra&o of the mesh size in the TAR plane to the defect area (median in cm) was 1200cm 2 /177cm 2 =6.8 in pa&ents without bridging, and 1750cm 2 /452cm 2 =3.8 in those with bridging.The dura&on of surgery (median in min) was 139 and 222 min and the hospital stay 6 and 10 days, respec&vely. Robo&c TAR was performed predominantly for lateral and parastomal hernias. The procedures took a median of 143 and 242 minutes, and the hospital stay was 2 and 3 days, respec&vely. For robo&c repair, posterior bridging was performed in 3 cases.Using the TAR technique, even complex hernias can be safely repaired. Addi&onal posterior bridging provides for reliable separa&on of the posterior plane from the intes&nes. Hence, the hernia sac is always available for anterior reconstruc&on of the linea alba. The technique can be implemented as open or minimally invasive procedure.