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Hernia : the journal of hernias and abdominal wall surgery, 2019-02, Vol.23 (1), p.5-15
2019

Details

Autor(en) / Beteiligte
Titel
Systematic review of transversus abdominis release in complex abdominal wall reconstruction
Ist Teil von
  • Hernia : the journal of hernias and abdominal wall surgery, 2019-02, Vol.23 (1), p.5-15
Ort / Verlag
Paris: Springer Paris
Erscheinungsjahr
2019
Link zum Volltext
Quelle
SpringerLink
Beschreibungen/Notizen
  • Background Transversus abdominis release (TAR), as a type of posterior component separation, is a new myofascial release technique in complex ventral hernia repair. TAR preserves rectus muscle innervation, creates an immense retromuscular plane and allows bilaminar ingrowth of the mesh. The place of the TAR within the range of established anterior component separation techniques (CST) is unclear. Aim of this systematic lite rature review is to estimate the position of the TAR in the scope of ventral hernia repair techniques. Methods MEDLINE, Embase, Pubmed and the Cochrane controlled trials register and Science citation index were searched using the following terms: ‘posterior component separation’, ‘transversus abdominis release’, ‘ventral hernia repair’, ‘complex abdominal wall reconstruction’. To prevent duplication bias, only studies with a unique cohort of patients who underwent transversus abdominis release for complex abdominal wall reconstruction were eligible. Postoperative complications and recurrences had to be registered adequately. The rate of surgical site occurrences and recurrences of the TAR were compared with those after anterior CST, published earlier in two meta-analyses. Results Five articles met our strict inclusion criteria, describing 646 TAR patients. Methodological quality per study was good. Mean hernia surface was 509 cm 2 and 88% of the hernias were located in the midline. Preoperative risk stratification was distributed in low risk (10%), co-morbid (55%), potentially contaminated (32%) and infected (3%). Pooled calculations demonstrated a mean SSO rate of 15% after TAR (20–35% after anterior CST) and a mean 2-year hernia recurrence rate of 4% (13% after anterior CST). Mean hernia surface was 300 cm 2 in anterior component separation studies. Conclusion This review demonstrates that the transversus abdominis release is a good alternative for anterior CST in terms of SSO and recurrence, especially in very large midline ventral hernias.

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