Laparoscopic Transversus Abdominis Release, a Novel Minimally Invasive Approach to Complex Abdominal Wall Reconstruction

Igor Belyansky, MD, FACS, Hamid R Zahiri, DO, Adrian E Park, MD, FACS. Anne Arundel Medical Center

Background: Transversus Abdominis Release (TAR) is previously described technique used in abdominal wall reconstruction (AWR) to repair complex abdominal wall hernias with contour abnormalities.  We present a novel minimally invasive TAR approach to address these types of defects, completed entirely laparoscopically.

Methods: A 61 year-old male with history of three failed hernia repairs after suffering a perforated appendicitis and abdominal sepsis in the 1990s, presented to our clinic with a large painful recurrent midline abdominal hernia.   We addressed this complex problem by performing laparoscopic TAR AWR.  This included lysis of adhesions, bilateral posterior rectus sheath release, bilateral transversus abdominis release, closure of the posterior fascial layer, closure of the anterior abdominal wall defect and large mesh implantation.   

Results: Use of laparoscopic TAR technique has several advantages when addressing complex abdominal defects.  It allows for a safe and comprehensive repair, while maintaining the principles of the open approach.  Furthermore, it alleviated the need for large abdominal incisions and the need to raise large subcutaneous flaps.  While the operative time was prolonged compared to the open approach, the physiologic burden of the procedure was significantly less to our patient.  He was off intravenous pain medications post-operative day (POD) 2, discharged home on POD 4 and completely off pain medication and at baseline function 7 days after surgery.  Finally, short-term follow-up showed no evidence of wound complications or recurrence.

Conclusion: Laparoscopic abdominal wall reconstruction with transversus abdominis release is a novel and feasible approach to complex abdominal wall defects with the potential to reduce pain, facilitate recovery and decrease length of hospital stay for patients.

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