Robotic Unilateral Transversus Abdominis Release for Lateral Incisional Hernias – Analysis of 14 Cases

Abstract Background Originally described for complex midline hernias, the transversus abdominis release (TAR) might be useful for the repair of lateral incisional hernias by facilitating the tension free defect closure and allowing a sufficient overlap of extraperitoneal placed meshes. Robotic surgery is the latest innovation in abdominal wall surgery. Method We present our data of 14 cases of robotic hernia repairs using TAR for lateral incisional hernias regarding perioperative data und early outcome. Results Between January 2023 and January 2024 14 robotic hernia repairs for lateral incisional hernias were performed. Mean defect diameter was 5 cm (range: 2–15 cm). Two patients presented with additional ventral hernias. All meshes were placed in the extraperitoneal space. Ipsilateral transversus abdominis release was performed in all 14 patients for tension free defect closure and for sufficient overlap of the implanted meshes (polypropylene, mean mesh dimension: 17 × 16 cm, 302 cm²). Mean operation time was 169 min (range: 76–343 min). In the postoperative course one patient underwent diagnostic laparoscopy to rule out bowel injury. Another patient underwent laparotomy on the first postoperative day for repair of a small bowel injury after extensive adhesiolysis (Mesh exchanged for bioresorbable scaffold with hydrogen barrier, discharge at day 7). The median hospital stay was 3 days (range: 2–7). Conclusion Robotic surgery for lateral incisional hernia repair with extraperitoneal mesh placement and defect closure using TAR shows promising perioperative results. Long-term results need to be further investigated.