Early postoperative outcome of posterior component separation through transversus abdominis release for the treatment of large midline incisional hernia

Background
Posterior component separation through transversus abdominis muscle release (PCS-TAR) is considered a better option for abdominal wall reconstruction during large ventral wall incisional hernia (IH) repair as it has advantage over both Rives-Stoppa (retromuscular) repair and anterior component separation 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.
Aim
To evaluate 30-day postoperative outcome of PCS-TAR regarding both visual analog scale and surgical site occurrence (SSOs) classification provided by Ventral Hernia Working Group (VHWG) in 2010.
Patients and methods
This prospective observational study was conducted on 30 patients who had a midline IH with defect size more than or equal to 10 cm in the widest diameter (W3) and underwent IH repair through PSC-TAR after routine laboratory investigations, abdominal ultrasonography, and computed tomography. Informed consent was taken from all cases. Results were reviewed and evaluated.
Results
Of 30 patients, 13 (43.3%) patients developed SSOs: three (10%) patients developed cellulitis; three (10%) patients presented with superficial infection; seroma occurred in five (16.7%) patients, comprising three (10%) patients who developed complicated seroma that needed procedural intervention (SSOpi); and hematoma was observed in two (6.7%) patients.
Conclusion
Retromuscular Rives-Stoppa technique and anterior component separation are comparable to PCS-TAR regarding patient-reported outcomes. However, PCS-TAR still has resulted in a better quality of life. The outcome of PCS-TAR is still better even in the presence of comorbidities such as high BMI, diabetes mellitus, and chronic obstructive pulmonary disease.