Repair of large incisional hernia using the transversus abdominis muscle release procedure in clinical practice

doi:10.3877/cma.j.issn.1674-392X.2018.03.009

Abstract

Abstract:

Objective

To investigate the clinical utility of the transversus abdominis muscle release (TAR) procedure in repair of large incisional hernia.

Methods

Retrospectively studied Twenty-five cases of large incisional hernia patients admitted to Hangzhou First People's Hospital from January 2016 to August 2017. Clinical materials were collected and analyzed.

Results

Among 25 cases of Large incisional hernia, there were 16 males (64.0%) and 9 females (36.0%). Mean age were (65.04±11.38) years, BMI were (31.15±5.83) kg/m². Mean width of abdominal defect were (11.40±1.36) cm. Twenty-two cases were midline incisional hernia, and three cases were lateral. Four cases were recurrent incisional hernia. All patients underwent retro-muscular mesh repair, and abdominal wall reconstruction using TAR procedure. The operation time was (152±31.6) minutes, and estimated blood loss was (116.8±44.1) cm³. Length of hospitalization were (13.9±2.9) days. We had 2 cases of superficial surgical site infection, 4 cases of type Ⅲ seroma, and 1 ileus. Postoperative complications were cured after non-surgical therapy. No mesh infection, fistula, recurrence, and postoperative bulging were found during the follow-up.

Conclusion

Posterior component separation via TAR is a reliable and effective technique for large incisional hernia repair.

Key words: Incisional hernia, Transversus abdominis muscle release, Posterior component separation, Abdominal wall reconstruction

Ping Wang, Yonggang Huang, Jing Ye, Guodong Gao, Fangjie Zhang, Hao Wu. Repair of large incisional hernia using the transversus abdominis muscle release procedure in clinical practice[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2018, 12(03): 194-198.

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References 32

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分级	缺损宽度和污染程度	风险度
Ⅰ级	<10 cm清洁	低SSO,低复发
Ⅱ级	<10 cm,污染;10~20 cm	中等SSO,中等复发
Ⅲ级	≥10 cm,污染;任何≥20 cm	高SSO,高复发

分级	缺损宽度和污染程度	风险度
Ⅰ级	<10 cm清洁	低SSO,低复发
Ⅱ级	<10 cm,污染;10~20 cm	中等SSO,中等复发
Ⅲ级	≥10 cm,污染;任何≥20 cm	高SSO,高复发

临床资料		统计值
性别[例(%)]		?
?	男	16(64.0)
?	女	9(36.0)
年龄(岁, ±s)		65.0±11.4
体质量指数(kg/m², ±s)		31.1±5.8
合并基础疾病[例(%)]		?
?	糖尿病	5(20.0)
?	慢性阻塞性肺疾病	4(16.0)
?	免疫抑制状态	2(8.0)
视觉模拟量表评分(分,±s)		2.72±1.10
切口疝分级[例(%)]		?
?	Ⅱ级	19(76.0)
?	Ⅲ级	6(24.0)
手术时间(min,±s)		152.8±31.6
术中出血(cm³,±s)		116.8±44.1
缺损大小(cm,±s)		11.4±1.4
补片大小(cm²,±s)		512.0±105.3
手术切口不良事件[例(%)]		6(24.0)
?	血肿[例(%)]	0
?	血清肿(Ⅲ、Ⅳ型)[例(%)]	4(16.0)
?	切口裂开[例(%)]	0
?	手术部位感染[例(%)]	2(8.0)
?	浅表感染[例(%)]	2(8.0)
?	深部感染[例(%)]	0
?	补片感染[例(%)]	0
其他术后并发症[例(%)]		?
?	肠梗阻	1(4.0)
?	肠瘘	0
?	住院时间(d,±s)	13.9±2.9
?	随访时间(个,±s)	12.20±5.57
?	复发[例(%)]	0
?	膨出[例(%)]	0

临床资料		统计值
性别[例(%)]		?
?	男	16(64.0)
?	女	9(36.0)
年龄(岁, ±s)		65.0±11.4
体质量指数(kg/m², ±s)		31.1±5.8
合并基础疾病[例(%)]		?
?	糖尿病	5(20.0)
?	慢性阻塞性肺疾病	4(16.0)
?	免疫抑制状态	2(8.0)
视觉模拟量表评分(分,±s)		2.72±1.10
切口疝分级[例(%)]		?
?	Ⅱ级	19(76.0)
?	Ⅲ级	6(24.0)
手术时间(min,±s)		152.8±31.6
术中出血(cm³,±s)		116.8±44.1
缺损大小(cm,±s)		11.4±1.4
补片大小(cm²,±s)		512.0±105.3
手术切口不良事件[例(%)]		6(24.0)
?	血肿[例(%)]	0
?	血清肿(Ⅲ、Ⅳ型)[例(%)]	4(16.0)
?	切口裂开[例(%)]	0
?	手术部位感染[例(%)]	2(8.0)
?	浅表感染[例(%)]	2(8.0)
?	深部感染[例(%)]	0
?	补片感染[例(%)]	0
其他术后并发症[例(%)]		?
?	肠梗阻	1(4.0)
?	肠瘘	0
?	住院时间(d,±s)	13.9±2.9
?	随访时间(个,±s)	12.20±5.57
?	复发[例(%)]	0
?	膨出[例(%)]	0

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