Outcomes of transversus abdominis release (TAR) with permanent synthetic retromuscular reinforcement for bridged repairs in massive ventral hernias: a retrospective review

• Published in: Hernia : the journal of hernias and abdominal wall surgery Vol. 24; no. 2; pp. 341 - 352
• Main Authors: Alkhatib, H., Tastaldi, L., Krpata, D. M., Petro, C. C., Fafaj, A., Rosenblatt, S., Rosen, M. J., Prabhu, A. S.
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01-04-2020; Springer Nature B.V
• Subjects: Abdominal Muscles - surgery; Abdominal Surgery; Adult; Aged; Computed tomography; Decision making; Fascia; Female; Forum on Complexities in Hernia; Hernia; Hernia, Ventral - surgery; Hernias; Herniorrhaphy - adverse effects; Herniorrhaphy - methods; Humans; Incisional Hernia - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Pain; Patient Reported Outcome Measures; Patients; Quality of Life; Recurrence; Reoperation; Retrospective Studies; Surgical Mesh; Treatment Outcome; Transversus abdominis release; Anterior fascia; Complex hernia; Bridged; TAR; Synthetic mesh
• ISSN: 1265-4906; 1248-9204
• DOI: 10.1007/s10029-019-02046-z

Purpose
In a subset of patients with massive and multiply recurrent hernias, despite performing a transversus abdominis release (TAR), anterior fascial re-approximation is not feasible and a bridged repair is required. We aim to report on the outcomes of this patient population at our institution.
Methods
Patients that underwent a TAR-bridged repair at the Cleveland Clinic were identified retrospectively within the Americas Hernia Society Quality Collaborative (AHSQC) database. Outcomes of interest were quality-of-life metrics measured through HerQLes and PROMIS pain intensity 3a and composite recurrence measured by patient-reported outcomes, physical examination, or CT imaging.
Results
Ninety-six patients met inclusion criteria. The mean hernia width was 26 ± 8 cm. The majority (93%) were incisional hernias and 71% were recurrent with 21% having five prior hernia repairs. Of those eligible for recurrence and QoL analysis, 54 (70%) had data points available. HerQLes scores showed a steady improvement throughout postoperative recovery (26 ± 21 at baseline, 44 ± 26 at 30-day follow-up, and 60 ± 33 at 6 months–3 years;
P
 < 0.001), as did the PROMIS Pain Intensity 3a scores (46 ± 11 at baseline, 45 ± 11 at 30-day follow-up, and 39 ± 11 at 6 months–3 years;
P
 = 0.001). At a mean follow-up of 20 ± 10 months, a composite recurrence of 46% was reported, primarily from patients reporting a “bulge” at the site.
Conclusion
Performing a bridged TAR repair with synthetic mesh in patients with complex hernias is associated with high rates of patient-reported bulge perception. Despite this, there was a significant improvement in quality-of-life metrics. When counseling these patients during preoperative evaluation, the results of our study should be shared in candor to aid in informed decision-making.