Posterior component separation by transversus abdominis release-current paradigm in management of large complex hernias: Our initial experience

• Published in: Current medicine research and practice 2018-07, Vol.8 (4), p.134-137
• Main Authors: Dey, Ashish, Malik, Vinod K., Kumar, Arun, Vashishta, Vasu, Agarwal, Bipul
• Format: Article
• Language: English
• Subjects: Component separation; Large complex ventral hernia; TAR
• ISSN: 2352-0817; 2352-0825
• DOI: 10.1016/j.cmrp.2018.06.001

Repair of large complex ventral hernia repair presents many difficulties to the hernia surgeon owing to large wide defects that are difficult to appose in the midline. PCS- TAR is one novel reconstructive technique that addresses the goals of hernia repair without tension and placement of extraperitoneal large mesh without tension. The retrorectus plane is entered by incising the posterior rectus sheath as in the modified Rives-Stoppa technique, the transversus abdominis muscle is released at its attachment medial to the linea semilunaris. This plane is dissected laterally to the psoas muscle in the retro-peritoneum preserving the neurovascular bundles supplying the recti. A large polypropylene mesh is placed with a large overlap. The posterior sheath and the linea alba is reconstructed in the midline creating a functionally physiological abdominal wall. Our patient was a 62 year old lady with a BMI of 29 with a large incisional hernia following multiple surgeries and loss of domain. The size of the defect was 7 × 8 cm in the midline with another defect laterally. PCS- TAR was performed under General anaesthesia and took slightly more than 4 h. There were no intraoperative complications. Follow-up at 5 weeks showed no wound infection, seroma or recurrence. TAR is a novel but effective technique in dealing with large complex hernias with loss of abdominal domain and gives good postoperative outcomes.