Unilateral Transversus Abdominis Muscle Release With Retromuscular Mesh Repair as a Solution for a Second Recurrence of Large Multilocular Incisional Hernia After Liver Transplantation

Background Transversus abdominis muscle release was published by Novitsky et al. in 2012. It is a posterior component separation technique allowing the closure of large abdominal wall defects and the insertion of very large retromuscular meshes without damaging the vessels and intercostal nerves. Method We would like to present a case of a second recurrence of a large multilocular incisional hernia after liver transplantation and its solution. Results We present a patient after liver transplantation in January 2021. In April 2022 retromuscular sublay mesh repair was performed for subcostal incisional hernia. In December 2022 onlay mesh repair was performed for medial recurrence of the previous incisional hernia. Four months later, unfortunately, the second recurrence appeared. At the beginning, we proceeded conservatively, but because of an increasing size of the hernia, we decided to perform a retromuscular mesh plastic. Because of the size of the defect (fascial gap 10 × 20 cm), with the transversus abdominis muscle release. Due to the violated tissue planes after previous plastics, we performed only unilateral (left) release. It was sufficient to close the posterior rectus sheath without any tension. Large retromuscular mesh was placed and covered by closure of the anterior rectus sheaths. The patient was discharged on the third postoperative day without any complications. Conclusion Transversus abdominis muscle release with retromuscular mesh placement provides a great solution for difficult recurrent ventral hernias.