Top

Hernia

Published in:

01-08-2018 | Original Article

Assessment of myofascial medialization following posterior component separation via transversus abdominis muscle release in a cadaveric model

Authors: A. Majumder, H. J. Miller, L. M. del Campo, H. Soltanian, Y. W. Novitsky

Published in: Hernia | Issue 4/2018

Abstract

Purpose

Posterior component separation (PCS) via the transversus abdominis release (TAR) procedure continues to gain popularity. However, neither the physiologic basis nor the extent of myofascial medialization after TAR is established. We aimed to assess both anterior and posterior rectus fascia (AF and PF) medialization following each step of the TAR procedure.

Methods

Ten fresh cadavers underwent PCS via TAR. Steps included midline laparotomy (MLL), retrorectus dissection (RRD), incision of the posterior rectus sheath (IPL), transversus abdominis muscle division (TAD), and retromuscular dissection (RMD). Medial advancement of AF and PF was measured following application of 2.5, 5.0 lb, and maximal tension to the fascial edge. Values are represented as mean advancement past midline in centimeters.

Results

MLL allowed advancement of 2.5, 3.7, and 4.9 cm. RRD provided advancement of 4.1, 5.9, and 7.6 cm for AF and 4.4, 6.2, and 7.5 cm for PF. IPL provided advancement of 4.2, 6.1, and 8.0 cm for AF and 4.6, 6.6, and 8.3 cm for PF. TAD provided advancement of 4.5, 6.6, and 8.6 cm for AF and 5.3, 7.5, and 9.5 cm for PF. RMD provided advancement of 5.5, 7.9, and 9.9 cm for AF and 6.9, 9.6, and 11.2 cm for PF. Overall, the complete TAR procedure provided AF advancement of 102% and PF advancement of 129%, over baseline.

Conclusions

The TAR procedure provides for substantial medial advancement of both anterior and posterior myofascial components of the abdominal wall. Retromuscular dissection deep to the divided transversus abdominis muscle appears to be the key step of the procedure, allowing for effective reconstruction of very wide (≈ 20 cm) defects.

Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ (2012) Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg 204:709–716. https://doi.org/10.1016/j.amjsurg.2012.02.008 CrossRefPubMed

Jones CM, Winder JS, Potochny JD, Pauli EM (2016) Posterior component separation with transversus abdominis release. Plast Reconstr Surg 137:636–646. https://doi.org/10.1097/01.prs.0000475778.45783.e2 CrossRefPubMed

Petro CC, Orenstein SB, Criss CN et al (2015) Transversus abdominis muscle release for repair of complex incisional hernias in kidney transplant recipients. Am J Surg. https://doi.org/10.1016/j.amjsurg.2014.08.043 PubMedCrossRef

Petro CC, Como JJ, Yee S et al (2015) Posterior component separation and transversus abdominis muscle release for complex incisional hernia repair in patients with a history of an open abdomen. J Trauma Acute Care Surg 78:422–429. https://doi.org/10.1097/TA.0000000000000495 CrossRefPubMed

Stoppa R, Petit J, Abourachid H et al (1973) Original procedure of groin hernia repair: interposition without fixation of Dacron tulle prosthesis by subperitoneal median approach. Chirurgie 99:119–123PubMed

Rives J, Pire JC, Flament JB et al (1985) Treatment of large eventrations. New therapeutic indications apropos of 322 cases. Chirurgie 111:215–225PubMed

Ramirez OM, Ruas E, Dellon AL (1990) “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 86:519–526CrossRefPubMed

Novitsky YW, Fayezizadeh M, Majumder A et al (2016) Outcomes of posterior component separation with transversus abdominis muscle release and synthetic mesh sublay reinforcement. Ann Surg. https://doi.org/10.1097/SLA.0000000000001673 PubMedCrossRef

Appleton ND, Anderson KD, Hancock K, Scott MH, Walsh CJ (2016) Initial UK experience with transversus abdominis muscle release for posterior components separation in abdominal wall reconstruction of large or complex ventral hernias: a combined approach by general and plastic surgeons. Ann R Coll Surg Engl 99(4):265–270. https://doi.org/10.1308/rcsann.2016.0241 CrossRefPubMed

10.

Espinosa-de-los-Monteros A, Avendano-Peza H, Novitsky YW (2016) Abdominal closure after TRAM flap breast reconstruction with transversus abdominis muscle release and mesh. Plast Reconstr Surg Glob Open 4:e1014. https://doi.org/10.1097/GOX.0000000000001014 CrossRefPubMedPubMedCentral

11.

Krpata DM, Blatnik J, Novitsky YW, Rosen MJ (2012) Posterior and open anterior components separations: a comparative analysis. Am J Surg 203:318–322. https://doi.org/10.1016/j.amjsurg.2011.10.009 discussion 322.CrossRefPubMed

12.

Pauli EM, Wang J, Petro CC et al (2014) Posterior component separation with transversus abdominis release successfully addresses recurrent ventral hernias following anterior component separation. Hernia. https://doi.org/10.1007/s10029-014-1331-8 PubMedCrossRef

13.

Timmermans L, De Goede B, Van Dijk SM et al (2014) Meta-analysis of sublay versus onlay mesh repair in incisional hernia surgery. Am J Surg 207:980–988. https://doi.org/10.1016/j.amjsurg.2013.08.030 CrossRefPubMed

Title: Assessment of myofascial medialization following posterior component separation via transversus abdominis muscle release in a cadaveric model
Authors: A. Majumder
H. J. Miller
L. M. del Campo
H. Soltanian
Y. W. Novitsky
Publication date: 01-08-2018
Publisher: Springer Paris
Published in: Hernia / Issue 4/2018
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-018-1771-7

At a glance: The STEP trials

Springer Medicine

Assessment of myofascial medialization following posterior component separation via transversus abdominis muscle release in a cadaveric model

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2018

Benefits of laparoscopic posterior wall suture repair in treating adolescent indirect inguinal hernias

Proportion of femoral hernia repairs performed for recurrence in the United States

Does the laparoscopic treatment of paediatric hydroceles represent a better alternative to the traditional open repair technique? A retrospective study of 1332 surgeries performed at two centres in China

Surgery for diverticular disease results in a higher hernia rate compared to colorectal cancer: a population-based study from Ontario, Canada

Reply to comment to: ‘Technical description of laparoscopic Morgagni hernia repair with primary closure and onlay composite mesh placement.’

Bowel obstruction secondary to migration of a Ventralex mesh: report of a rare complication