Laparoscopic transversus abdominis release for complex ventral hernia repair: technique and initial findings

Hernia. 2024 Jun;28(3):761-767. doi: 10.1007/s10029-023-02860-6. Epub 2023 Aug 28.

Abstract

Purpose: The open Rives-Stoppa retrorectus and transversus abdominis release (TAR) techniques are well established in open ventral and incisional hernia repair. The principles are currently being translated into minimally invasive surgery with different concepts. In this study, we investigate our initial results of transperitoneal laparoscopic TAR for ventral incisional hernia repair (laparoscopic TAR).

Methods: Over a 20-month period, 23 consecutive patients with incisional hernias underwent surgery. Laparoscopic TAR was performed transperitoneally with adhesiolysis from the anterior abdominal wall, development of the retrorectus space and TAR, midline reconstruction and extraperitoneal mesh reinforcement.

Results: There were 23 incisional hernias, of which 70% were M2-M4 and 60% were W3. Median patient age was 68 years and the median BMI was 31. Median operating time was 313 min, and hospital stay was 4 days. Morbidity was 26% (Clavien-Dindo 1: n = 4 and 2 + 3b: n = 2).

Conclusion: With the laparoscopic TAR, it was possible to treat a series of patients with ventral incisional hernias. The operating times were long. However, with a low rate of perioperative complications the hospital stay was short As feasibility is demonstrated, the clinical relevance of the method has to be further evaluated.

Keywords: Extraperitoneal mesh; Incisional hernia; Laparoscopic TAR; Minimally invasive surgery; Robotic surgery.

MeSH terms

  • Abdominal Muscles* / surgery
  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Hernia, Ventral* / surgery
  • Herniorrhaphy* / methods
  • Humans
  • Incisional Hernia* / surgery
  • Laparoscopy* / methods
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Operative Time*
  • Surgical Mesh