Prospective comparative study between open perforator-preserving anterior component separation and transversus abdominis release operation in patients with large midline incisional hernia

Background
Ventral hernia repair is one of the most common operations performed nowadays. Ventral hernia presents a true challenge to the surgical team especially when huge and complex.
Objective
To evaluate postoperative morbidity and recurrence rate when using transversus abdominis release (TAR) technique in the management of large midline incisional hernia in comparison with open perforator-preserving anterior component separation. This study was conducted at Ain Shams University Hospitals.
Patients and methods
This was a randomized prospective comparative study that was carried out at Ain Shams University Hospitals on 70 patients diagnosed as having large midline incisional hernia with a defect equal to or more than 10 cm in width and operated upon between February 2018 and October 2019 with minimal follow-up of 24 months postoperatively. The patients were treated using TAR technique and open perforator-preserving anterior component separation.
Results
The perforator-preserving technique has less operative time by ~38 min when compared with the TAR technique, as the mean±SD operative time in TAR was 259.17 ± 43.29 min, whereas in the perforator-preserving technique was 221.62 ± 51.45 min. The postoperative pain assessment at 48 h postoperatively shows that the mean visual analog scale score for group A (TAR) was 5.86 ± 1.62 and for group B was 4.55 ± 1.51. We also found that the mean hospital stay was higher when performing the TAR technique (6.6 days), whereas it was 4.25 days after the perforator-preserving approach. There is nearly equal percentage of postoperative wound complications and also no statistically significant different in the rate of recurrence between both methods, and incidences of wound complication and recurrence are significantly less than the classic commonly used method of anterior component separation.
Conclusion
After this comparative study, both TAR and perforator-preserving technique are effective and reliable methods in experienced hands, and if there is no special indication for either of them, the choice between both should depend on surgeon preference and experience.