Abstract
Background
Posterior component separation with transversus abdominis release technique is increasingly being used for abdominal wall reconstruction in complex abdominal wall repair. The main purpose of this study is to present a modification of the surgical technique originally described that facilitates the surgical procedure and offers additional advantages.
Methods
Based on the knowledge of the anatomy of the retromuscular space and the preperitoneal aerolar tissue distribution, we start the incision on the posterior rectus sheath from the arcuate line in a down to up direction. The posterior rectus sheath is incised 0,5–1 cm medial to the linea semilunaris and cut longitudinally as far as the fibers of transversus abdominis muscle that are divided in the superior part of the abdomen. It is also possible to avoid cutting the fibers of this muscle if we incise the posterior rectus sheath in an oblique direction to the midline from the umbilical area. Since 2012 to 2016, 69 consecutive patients with down to up TAR have been prospectively followed. Main outcome measures included demographics, perioperative details, wound complications, and recurrences.
Results
Between 2012 and 2016, we have operated 69 patients with down to up TAR technique. Mean operative time was 251 (range 65–566) minutes. Mean hospital stay was 9,8 (2–98) days. 10 patients presented surgical site events (14,5%): 6 patients had superficial site infection, 3 deep and 1 organ space. During follow-up, 3 patients (4,3%) presented incisional hernia recurrence.
Conclusions
This novel modification allows a simpler dissection of the preperitoneal retromuscular space and makes the TAR technique easier to perform. It also enables to incise only the insertion of the transversalis fascia cranially.
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Conflict of interests
- Alvaro Robin-Lersundi: received honorarium for Gore for organizing workshops on abdominal wall surgery.
- Miguel-Angel García-Ureña: received honorarium for Gore for organizing workshops on abdominal wall surgery and has been an invited speaker in symposium organized by B. Braun.
- Luis Blaquez Hernando: received honorarium for Gore for organizing workshops on abdominal wall surgery.
- Javier López-Monclús: received honorarium for Gore for organizing workshops on abdominal wall surgery.
- Arturo Cruz Cidoncha: declares no conflict of interest.
- Carlos San Miguel: declares no conflict of interest.
- Elena Jimenez Cubedo: declares no conflict of interest.
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This article does not contain any studies with animals performed by any of the authors.
All procedures performed in this study with human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Robin-Lersundi, A., Blazquez Hernando, L., López-Monclús, J. et al. How we do it: down to up posterior components separation. Langenbecks Arch Surg 403, 539–546 (2018). https://doi.org/10.1007/s00423-018-1655-4
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DOI: https://doi.org/10.1007/s00423-018-1655-4