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01-12-2021 | Original Article

Outcomes of redo-transversus abdominis release for abdominal wall reconstruction

Authors: K. C. Montelione, S. J. Zolin, A. Fafaj, J. D. Thomas, C. M. Horne, K. Baier, B. C. Perlmutter, S. Rosenblatt, D. M. Krpata, A. S. Prabhu, C. C. Petro, M. J. Rosen

Published in: Hernia | Issue 6/2021

Abstract

Background

Transversus abdominis release (TAR) is increasingly used to address complex ventral hernias; consequently, associated complications are seen more frequently. Our hernia center has a growing experience with redo-transversus abdominis release (redo-TAR) to address large, complex hernia recurrences after failed TAR. Here, we describe our outcomes after abdominal wall reconstruction with redo-TAR.

Study design

Adults undergoing elective open, redo-TAR at our institution from January 2015 to February 2021 were queried from a prospectively collected database in the Abdominal Core Health Quality Collaborative. The primary outcome was 30-day wound morbidity. Secondary outcomes were long-term composite hernia recurrence and patient-reported quality of life.

Results

Sixty-five patients underwent redo-TAR. Median age was 60 years, 50.8% were female, and median BMI 31.8 kg/m². Median recurrent hernias were 16 cm wide by 25 cm long. Frequent mechanisms of recurrence included linea semilunaris injury (27.7%), mesh fracture (18.5%), infection (16.9%), and posterior sheath disruption (15.4%). Wound complications occurred in 33.8% and 16.9% required procedural intervention. With median clinical and PRO follow-up of 12 and 19 months, respectively, the composite hernia recurrence rate was 22.5% and patients reported significantly improved quality of life (HerQLes: median + 36.7, PROMIS: median – 9.5).

Conclusion

Redo-TAR may be performed as a salvage procedure to reconstruct complex defects after failed TAR, however, in our center, it is associated with increased wound morbidity and fairly high composite recurrence rates. Despite this, patients report improvements in quality of life and pain. Tracking outcomes after TAR will facilitate understanding how to manage its failures.

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Title: Outcomes of redo-transversus abdominis release for abdominal wall reconstruction
Authors: K. C. Montelione
S. J. Zolin
A. Fafaj
J. D. Thomas
C. M. Horne
K. Baier
B. C. Perlmutter
S. Rosenblatt
D. M. Krpata
A. S. Prabhu
C. C. Petro
M. J. Rosen
Publication date: 01-12-2021
Publisher: Springer Paris
Published in: Hernia / Issue 6/2021
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-021-02457-x

At a glance: The STEP trials

Springer Medicine

Outcomes of redo-transversus abdominis release for abdominal wall reconstruction

Abstract

Background

Study design

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Study design

Results

Conclusion

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