S Shirazi, MD, J Janzen, MD, S D Pooler, MD, FRCSC, G K Kaban, MD, FRCSC. University of Saskatchewan
Introduction: Repair of midline incisional hernias utilizing posterior component separation and transversus abdominus release (PCS/TAR) was first described in 2006. The technique is growing in popularity for incisional hernia repair with several large series documenting its success. There are no reports demonstrating its utilization in low volume centres. Our aim was to evaluate our outcomes with PCS/TAR incisional hernia repair in the first series of patients in our institution.
Methods and Procedures: Following ethics board approval, patients with a history of PCS/TAR hernia repair were identified retrospectively from the health records of our institution, performed by our senior author during the period of 2009-15. Patient demographics, hernia characteristics, indications, and short term outcomes were collected. Patients were invited to undergo evaluation by a non-operative surgeon for signs of clinical recurrence. Participating patients completed a survey regarding overall satisfaction and quality of life with repair.
Results: A total of 18 PCS/TAR repairs were performed. Patient participation for follow-up was 61% (11/18). Average patient age was 64 years. Average operative time was 3hrs 50mins and length of hospital stay was 5.2 days. Average mesh size was 633cm2. Mesh was uncoated polypropylene in the majority of cases (16/18). Surgical site occurrences (SSO) occurred in 5 patients. SSO risk stratified by the Ventral hernia Working Group (VHWG) classification was: 1 (28%), 2 (50%), 3(22%), 4 (0%). Three (11%) patients needed explantation of the mesh due to non-resolving infection. All three patients requiring mesh explanation were VHWG 3 accompanied by closure of stoma or repair in the presence of a stoma. Early recurrence rate was 18% (2/11), occuring in a patient with biologic mesh repair only, and one patient with a 2cm recurrence inferior to the mesh requiring operative repair. Patient satisfaction was excellent (by Likard scale, mean 7/10, median 10/10) as was patients self-reported improvement in quality of life (mean 8/10, median 9/10).
Conclusions: PCS/TAR is associated with a low peri-operative wound morbidity when performed in patients with a low VHWG classification. Caution should be excercised when entertaining simultaneous repair of large hernias and closure of stomas due to a high risk of wound infection in our series. Short-term recurrence rates appear acceptable within the limits of the follow-up. Patient satisfaction and quality of life following this procedure appears to be high. This technique may be utilized in a low volume centre with good outcomes and low early hernia recurrence rates.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86621
Program Number: P033
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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