Jones Christine M, Winder Joshua S, Potochny John D, Pauli Eric M
Hershey, Pa. From the Divisions of Plastic Surgery and Minimally Invasive and Bariatric Surgery, Penn State Hershey Medical Center.
Plast Reconstr Surg. 2016 Feb;137(2):636-646. doi: 10.1097/01.prs.0000475778.45783.e2.
Ventral hernia formation is a frequent and increasingly difficult problem. Nonmidline hernias, parastomal hernias, hernias near bony landmarks, and recurrent ventral hernias (especially after anterior component separation) present particular challenges. Typical reconstructive techniques may struggle to reestablish abdominal domain and to create a lasting repair. Posterior component separation with transversus abdominis release is a novel technique that offers a durable solution to a variety of complex ventral hernias.
The posterior rectus sheath is incised and the retrorectus plane is developed. In a modification of the Rives-Stoppa technique, the transversus abdominis is released medial to the linea semilunaris to expose a broad plane that extends from the central tendon of the diaphragm superiorly, to the space of Retzius inferiorly, and laterally to the retroperitoneum. This preserves the neurovascular bundles innervating the medial abdominal wall. Mesh is placed in a sublay fashion above the posterior layer. In an overwhelming majority of patients, the linea alba is reconstructed, creating a functional abdominal wall with wide mesh reinforcement.
The technique is reliable and durable, with a 5 percent recurrence rate at 2 years. Although wound complications occur with a frequency similar to that of other techniques, they tend to be less severe, rarely requiring operative débridement. The technique is applicable to a broad range of hernias, including midline, parastomal, flank, subcostal, and recurrent hernias after prior component separations.
Posterior component separation with transversus abdominis release is a versatile, easy-to-learn technique of hernia repair that offers a reliable, durable solution to complex abdominal wall reconstruction.
腹疝形成是一个常见且日益棘手的问题。非中线疝、造口旁疝、靠近骨性标志的疝以及复发性腹疝（尤其是在进行前入路组织分离术后）带来了特殊挑战。典型的重建技术在重建腹腔区域和实现持久修复方面可能会面临困难。经腹横肌松解的后入路组织分离术是一种新颖的技术，可为各种复杂的腹疝提供持久的解决方案。
切开腹直肌后鞘并分离腹直肌后间隙。在改良的Rives-Stoppa技术中，在半月线内侧松解腹横肌，以暴露一个宽阔的平面，该平面上起自膈中心腱，下至Retzius间隙，外侧至腹膜后间隙。这样可保留支配腹前壁内侧的神经血管束。将补片以衬于腹膜后的方式置于后层上方。绝大多数患者的白线得到重建，形成了一个有广泛补片加强的功能性腹壁。
该技术可靠且持久，2年复发率为5%。尽管伤口并发症的发生率与其他技术相似，但往往不太严重，很少需要手术清创。该技术适用于多种疝，包括中线疝、造口旁疝、侧腹壁疝、肋下疝以及先前组织分离术后的复发性疝。
经腹横肌松解的后入路组织分离术是一种通用且易于学习的疝修补技术，可为复杂的腹壁重建提供可靠、持久的解决方案。
