Fortis Healthcare, Mumbai, India.
Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, 6th Floor, Main Hospital Building, Sir JJ Hospital Campus, Byculla, Mumbai, 400008, India.
Hernia. 2021 Apr;25(2):353-364. doi: 10.1007/s10029-020-02202-w. Epub 2020 May 6.
Transversus abdominis release (TAR) is a relatively recent surgical technique for ventral hernia repair which allows placement of a large prosthesis in the retro-muscular plane with considerable myofascial medialization. A retrospective review of 100 cases who underwent TAR for complex ventral hernias was performed to evaluate the safety and efficacy of TAR in a series of large ventral hernias.
Between March 2016 and May 2019, 100 consecutive patients who underwent open TAR were identified from our prospectively maintained database. A retrospective review was performed to analyze patient demographics, peri-operative events, adverse outcomes and recurrence.
12 primary and 88 incisional hernia cases underwent TAR with prosthetic mesh repair during the study period. Mean age was 52.5 years, mean BMI was 30.87 kgs/m, mean ASA class 1.95. In our series, 41% were diabetic, 11% had COPD. All patients underwent preoperative CT scans. The mean defect was 140.18 cm. Average mesh area was 1344 cm. Average blood loss was 245 mL. Defects were bridged in 19% cases despite bilateral component separation. Readmission rate at 1 month was 3%, for wound complications. We recorded 9 surgical site infections, 17 surgical site occurrences, 10 of which needed procedural interventions. We recorded no recurrences at a mean follow-up duration of 20.2 months.
Our early results with TAR are encouraging. We have demonstrated that the repair allows anatomical reconstruction with a large sublay mesh while inflicting minimal morbidity. TAR can be a valuable tool in complex ventral hernia repair.
腹横肌释放术（TAR）是一种用于腹疝修补的较新的外科技术，它允许在肌肉内平面放置大型假体，并进行相当大的筋膜内侧化。对 100 例接受 TAR 治疗复杂腹疝的病例进行回顾性分析，以评估 TAR 在一系列大型腹疝中的安全性和有效性。
在 2016 年 3 月至 2019 年 5 月期间，从我们前瞻性维护的数据库中确定了 100 例连续接受开放 TAR 的患者。进行回顾性分析以分析患者人口统计学、围手术期事件、不良结果和复发情况。
在研究期间，12 例原发性和 88 例切口疝患者接受了 TAR 联合补片修复。平均年龄为 52.5 岁，平均 BMI 为 30.87kg/m，平均 ASA 分级为 1.95。在我们的系列中，41%的患者患有糖尿病，11%的患者患有 COPD。所有患者均行术前 CT 扫描。平均缺损为 140.18cm。平均补片面积为 1344cm。平均失血量为 245mL。尽管进行了双侧组件分离，但仍有 19%的病例存在缺损桥接。术后 1 个月的再入院率为 3%，与伤口并发症有关。我们记录了 9 例手术部位感染，17 例手术部位事件，其中 10 例需要进行程序性干预。在平均随访 20.2 个月时，未发现复发。
我们使用 TAR 的早期结果令人鼓舞。我们已经证明，该修复术可以通过大的下置补片进行解剖重建，同时造成最小的发病率。TAR 可成为复杂腹疝修复的有效工具。
