Posterior component separation with transversus abdominis release (TAR) for repair of complex incisional hernias after orthotopic liver transplantation

Hernia : the Journal of Hernias and Abdominal Wall Surgery
Luciano TastaldiMichael Rosen

Abstract

Incisional hernias (IH) after orthotopic liver transplant (OLT) are challenging due to their concurrent midline and subcostal defects adjacent to bony prominences in the context of lifelong immunosuppression. To date, no studies evaluated the posterior component separation with transversus abdominis release (TAR) to repair complex IH after OLT. We aim to report the outcomes of TAR in this scenario. OLT patients who underwent open, elective IH repair with TAR performed at two centers and with a minimum of 1-year follow-up were identified in the Americas Hernia Society Quality Collaborative (AHSQC). Outcomes included 30-day surgical site infections (SSI), surgical site occurrences requiring procedural intervention (SSOPI), unplanned readmissions, reoperations, and hernia recurrence. Forty-four patients were identified (mean age 60 ± 8, 75% male, median BMI 30.7 kg/m2) at two centers. Median hernia width was 20 cm [IQR 15-28] and 98% (43) were clean cases. Retromuscular synthetic mesh was used in all cases, and 93% (41) achieved fascial closure with no intraoperative complications. Postoperatively, there were 5 SSIs (4 deep, 1 superficial), 6 SSOPIs (4 wound opening, 1 debridement, 1 seroma drainage), four (9%) readmissions, and 3...Continue Reading

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Citations

Mar 11, 2020·Hernia : the Journal of Hernias and Abdominal Wall Surgery·S J ZolinD M Krpata
Nov 5, 2019·The Surgical Clinics of North America·Danica N GiuglianoEric K Johnson
Feb 16, 2021·Langenbeck's Archives of Surgery·Nadav NevoE Karin
Dec 28, 2021·Asian Journal of Endoscopic Surgery·Katsuhito SuwaKen Eto

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