Early postoperative outcome of Posterior Component Separation through Transversus Abdominus Release for the treatment of Large Midline Incisional Hernia

Abstract

Background: Posterior Component Separation through Transversus abdominus Muscle Release (PCS-TAR) is considered as a better option for Abdominal Wall Reconstruction (AWR) during large ventral wall IH repair as it has advantage over both Rives-Stoppa (Retro muscular) repair and Anterior Component Separation (ACS) repair in avoiding injury of the nerve supply to rectus muscle, and in the ability to achieve more lateral dissection, providing better quality of life (QoL). Aim of work: to evaluate 30-day post operative outcome of PCS-TAR regarding both; Visual Analogue Scale (VAS) and Surgical Site Occurrence (SSOs) classification provided by Ventral Hernia Working Group (VHWG) in 2010. Patients and methods: This prospective observational study was conducted to 30 patients who have a midline incisional hernia with defect size ≥ 10 cm in widest diameter (W3) and underwent IH repair through (PSC-TAR) after routine laboratory investigations, abdominal ultrasonography, and CT. Informed consent was taken from all cases. Results were reviewed and evaluated. Results: Out of 30 patients, 13 patients (43.3%) developed SSOs. 3 patients (10%) developed cellulitis. 3 patients (10% of patients) presented with superficial infection. Seroma occurred in 5 patients (16.7%) 3 of which (10%) developed complicated seroma that needed procedural intervention (SSOpi). Hematoma was observed in 2 patients (6.7%). Conclusion: Retro muscular, Rives Stoppa technique and ACS are comparable to PCS-TAR regarding patient reported outcomes (PROs). However, PCS-TAR still has resulted in a better quality of life (QoL). The outcome of PCS-TAR is still better even in the presence of comorbidities such as high BMI, DM, and COPD. Keywords: Posterior Component Separation through Transversus Abdominis Release, Incisional Hernia Repair, Surgical Site Occurrence.