Sequential surgeries following transversus abdominis release for abdominal wall reconstruction: Insights from a single-center analysis

Nir Messer; Ryan C Ellis; Sara M Maskal; Jenny H Chang; Ajita S Prabhu; Benjamin T Miller; Lucas Ra Beffa; Clayton C Petro; Serrgio Mazzola Poli de Figueiredo; Aldo Fafaj; Varisha Essani; Michael J Rosen

doi:10.1016/j.amjsurg.2024.03.015

Sequential surgeries following transversus abdominis release for abdominal wall reconstruction: Insights from a single-center analysis

Am J Surg. 2024 Mar 27:S0002-9610(24)00176-4. doi: 10.1016/j.amjsurg.2024.03.015. Online ahead of print.

Affiliations

¹ Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA; Department of Surgery, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel -Aviv University, Tel Aviv, Israel. Electronic address: masrinir@gmail.com.
² Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
³ Case Western Reserve University School of Medicine, Cleveland, OH, USA.

PMID: 38580567
DOI: 10.1016/j.amjsurg.2024.03.015

Abstract

Introduction: Abdominal surgery following transversus abdominis release (TAR) procedure commonly involves incisions through the previously implanted mesh, potentially creating vulnerabilities for hernia recurrence. Despite the popularity of the TAR procedure, current literature regarding post-AWR surgeries is limited. This study aims to reveal the incidence and outcomes of post-TAR non-hernia-related abdominal surgeries of any kind.

Methods: Adult patients who underwent non-hernia-related abdominal surgery following ventral hernia repair with concurrent TAR procedure and permanent synthetic mesh in the Cleveland Clinic Center for Abdominal Core Health between January 2014 and January 2022 were queried from a prospectively collected database in the Abdominal Core Health Quality Collaborative. We evaluated 30-day wound morbidity, perioperative complications, and long-term hernia recurrence.

Results: A total of 1137 patients who underwent TAR procedure were identified, with 53 patients (4.7%) undergoing subsequent non-hernia-related abdominal surgery post-TAR. Small bowel obstruction was the primary indication for reoperation (22.6%), and bowel resection was the most frequent procedure (24.5%). 49.1% of the patients required urgent or emergent surgery, with the majority (70%) having open procedures. Fascia closure was achieved by absorbable sutures in 50.9%, and of the open cases, fascia closure was achieved by running sutures technique in 35.8%. 20.8% experienced SSO, the SSOPI rate was 11.3%, and 26.4% required more than a single reoperation. A total of 88.7% were available for extended follow-up, spanning 17-30 months, resulting in a 36.1% recurrent hernia diagnosis rate.

Conclusions: Abdominal surgery following TAR surgery is associated with significant comorbidities and significantly impacts hernia recurrence rates. Our study findings underscore the significance of making all efforts to minimize reoperations after TAR procedure and offers suggestions on managing the abdominal wall of these complex cases.

Keywords: Abdominal wall reconstruction; Component separation; Sequential surgeries; Transversus abdominis release; Ventral hernia repair.