Oprea Valentin, Radu Victor Gheorghe, Moga Doru
Chirurgia (Bucur). 2016 Nov-Dec;111(6):535-540. doi: 10.21614/chirurgia.111.6.535.
complex ventral hernia repair is a frequent and challenging topic. Reconstructive techniques are numerous but most of them are unable to achieve the goals of hernioplasty. Posterior component separation with transverses abdominis muscle release (TAR) is a novel approach that offers a solution for 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 retro-peritoneum. 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. Between November 2014 and July 2016 we used this procedure in 24 patients (14 males) with large median ventral incisional hernias. The recurrence in various degrees was present in 18 patients (75%). The average size of the defect was 18,3 cm. in width (12 to 28 cm.). Five patients (21%) developed various wound complications requiring reoperation. Follow-up between 2 and 18 months (11,8 months) without recurrence.
TAR seems to be the "ideal" approach for complex hernias with good immediate outcomes.
复杂腹疝修补是一个常见且具有挑战性的课题。重建技术众多，但大多数无法实现疝修补术的目标。腹横肌松解的后入路成分分离术（TAR）是一种为复杂腹疝提供解决方案的新方法。
切开腹直肌后鞘并游离腹直肌后间隙。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，该平面上起自膈肌中心腱，下至Retzius间隙，外侧至腹膜后间隙。这样可保留支配腹壁内侧的神经血管束。补片以衬于腹膜后间隙的方式置于后层上方。在绝大多数患者中，重建白线，形成一个有宽大补片加强的功能性腹壁。2014年11月至2016年7月，我们对24例（14例男性）大型正中腹直肌切口疝患者采用了该手术方法。18例患者（75%）出现不同程度的复发。缺损平均宽度为18.3cm（12至28cm）。5例患者（21%）出现各种伤口并发症，需要再次手术。随访2至18个月（平均11.8个月），无复发。
TAR似乎是治疗复杂疝的“理想”方法，近期效果良好。
