Transversus Abdominis Muscle Release (Tar) in Giant Incisional Hernia

Abstract Background We present a case of giant ventral incisional hernia, where a favorable outcome was achieved with Transversus Abdominis Muscle Release technique (TAR), in a contaminated environment without perioperative complications and recurrence after 36 months, with the placement of inexpensive non-absorbable ‘Paha’ mesh. Materials and Methods A 70-year-old man, who had undergone two previous operations presented with a giant incisional hernia. The rectus defect in the umbilical region was 20 cm in the transverse direction wide and 20 cm in the vertical direction and a defect area of 400 cm2 with the bowel adherent to the skin. We were compelled to resect approximately 15 cm of the intestine tenui and constructed a T-T anastomosis, alert to the risk of the operating field contamination. Two non-absorbable, monofilament polypropylene mesh sized 30 × 30 cm were placed retro muscular. Results The problem of extending the dissection from the rectus abdominis muscle to the lateral compartment was resolved by Novitsky et al. Mesh is placed sublay and perforators to the rectus muscle are preserved. TAR could be an ideal hernia repair technique for complex defects because it weakens the lateral sides of the abdominal wall to augment the midline repair, thereby also increasing the lateral abdominal wall compliance and reducing the pressure on the midline. Conclusion Our case shows that even the most challenging abdominal wall hernias can be reconstructed with TAR. It is a safe, effective, and reliable technique with low perioperative morbidity (reduced risk of skin necrosis and surgical site infection).