Advances in abdominal wall reconstruction: myofascial advancement techniques and urgent policy implications for Korea

Incisional hernia occurs in up to 20% of patients following laparotomy and represents a significant surgical challenge.Since Ramirez et al.'s landmark 1990 description of anterior component separation, surgical techniques have evolved dramatically, with a paradigm shift occurring in 2012 when Novitsky et al. introduced posterior component separation with transversus abdominis release (TAR).This review comprehensively examines the evolution of myofascial advancement techniques from 1990 through 2026, based on a structured literature search of PubMed, Embase, and Cochrane databases covering comparative studies, systematic reviews, and meta-analyses, and provides practical surgical guidance.TAR demonstrated superior outcomes compared to anterior component separation, with 2-year recurrence rates of approximately 4% vs. 13%.Surgical site occurrences were reduced with TAR (15%) compared to open anterior approaches (21.4%).However, these procedures require significant learning curves (50-100 cases) and operative times exceeding 4 hours.Recurrence rates are substantially higher in recurrent hernias (30.6%) compared to primary hernias (18.1%).While TAR represents a major advancement in complex abdominal wall reconstruction, its adoption requires specialized training programs, appropriate reimbursement systems, and recognition of the increased complexity of recurrent hernia repairs.Establishing tiered payment systems, developing fellowship training programs, and creating national registries are essential for advancing this field and improving patient outcomes.