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Introduction Among many other techniques for Abdominal Wall Reconstruction (AWR), posterior component separation with Transversus Abdominis Release (TAR), continues to gain popularity and it is increasingly used with promising long-term results. Our goal was to evaluate the influence of TAR with mesh retromuscular reinforcement on the intra-abdominal pressure (IAP) and respiratory function in a series of patients with complex incisional hernias (IH). Methods Since November 2014 through February 2019, patients with TAR were identified in the Clinical Department of Surgery database and were retrospectively reviewed. Outcome measures include: demographics, pre- and perioperative details, preoperative and postoperative IAP and plateau pressure (PP). Results One-hundred-and-one consecutive TAR procedures (19.7% from all incisional hernia repairs) were analyzed. Mean age was 63 years with a mean Body Mass Index (BMI) of 31.85 kg/m2 (25–51). Diabetes and Chronic Obstructive Pulmonary Disease (COPD) were the main major comorbidities. Mean hernia defect area was 247 cm2 (104–528 cm2). Conclusion TAR is a safe and sound procedure with acceptable modifications of the IAP morbidity and recurrence rate when correctly performed on the right patient.

BACKGROUND: Incisional hernia (IH) is the most frequent complication of laparotomy with an increasing incidence over time. A large amount of them present in complex forms with large defects or even loss of domain. There is still no consensus regarding the optimal surgical approach for this IHs. The posterior component separation with transversus abdominis release (TAR) alone or in combination with augmentation of the abdominal wall became the standard of repair in large IHs (LIH). No clear evidence that TAR alone can recreate the normal volume of the peritoneal cavity is available. We assessed if it is possible to reconstruct normal peritoneal volume (PV) by TAR. MATERIALS AND METHODS: In this retrospective study, data from LIH patients with midline defects equal or larger than 10 cm width, and computed tomography scans available before and 1-week after TAR with complete fascial closure were analyzed. Hernia sac volume (HSV), abdominal cavity volume (ACV), and (PV = HSV + ACV) were evaluated before surgery. Peritoneal index (PI) was calculated as HSV/PV ratio. PV was measured at 7 days post-TAR (PVTAR). The compliance of the abdominal wall (Cab) was calculated as the ratio between the difference of the PV before surgery and after TAR and the difference between preoperative intra-abdominal pressure (IAP) and postoperative IAP. RESULTS: 23 consecutive patients with a mean age of 64 years were included in the study. The mean value of the HSV was 3,775 cm3 and of the ACV 8377 cm3. PI varied between 0.22 and 0.4. A statistically insignificant difference was recorded between PV and PVTAR(P = 0.7). Patients with PI ≥0.3 had the volume of the peritoneal cavity lesser than patients with PI

Background: Both umbilical and epigastric hernias may be associated with rectus muscle divarication. In such cases, isolated repair of combined hernia defects can have high recurrence rates and poorer cosmetic outcomes, thus the repair of both pathologies ought to be favored. The goal of the study below is to provide detailed technical aspects of the endoscopic retro-rectus mesh repair. Methods: We chose a group of 16 patients who underwent the repair of ventral hernias associated with both primary and incisional rectus diastasis, using the extended-view of a totally extraperitoneal Rives-Stoppa repair (eRives) technique. All defects were < 6 cm in width. Our outcome measures perioperative complications and early recurrences. Results: The approach used in our study has led to zero cases of perioperative complications and only one early recurrence. Conclusions: We believe that the e-Rives repair is the optimal approach for ventral hernias associated with diastasis recti. This technique additionally produces favorable cosmetic outcomes that granted our results a well-deserved recognition in the medical literature.

Abstract Background Umbilical and epigastric hernias are sometimes associated with rectus muscle divarication. Isolated repair of the hernia defect can have a high recurrence rate and bad cosmetic results .With this condition the repair of both pathologies is mandatory. The goal of the study is to detail some technical aspects of the endoscopic retro-rectus mesh repair. Methods We present a small series of 15 patients operated for primary or incisional ventral hernias associated with rectus diastasis. The width of the defect was under 6 cm. The performed procedure was eRives repair. Results There were no perioperative complications or short term recurrences. Conclusions In our opinion eTEP access Rives Stoppa repair is the best choice for ventral hernias associating rectus diastasis. The technique has to be promoted for its cosmetic results, reproducibility and for acquiring the principles of modern hernia surgery. Key words: umbilical hernia, diastasis recti, extended-view totally extraperitoneal, eTEP

Background: complex groin hernia is a well describe entity with a high risk of recurrence and postoperative complications. There is no standardized approach and no reports to confirm the efficcacy of a surgical procedure. Our goal was to compare Lichtenstein repair (LR) as "golden standard" for open anterior approach with the transinguinal preperitoneal plasty (TIPP) in the treatment of complex groin hernia repair. Material and methods: the study was a prospective one and includes all patients with complex hernias admitted in the Department of Surgery of the Military Hospital Cluj-Napoca between January 2010 and December 2014. All the patients were randomized in two groups: LR and TIPP. Baseline characteristics, intraoperative findings, pain and complications were recorded. Follow-up was at least 1 year. The main outcome after 1 year were recurrence, chronic pain and its intensity recorded on VAS scale. Results: 205 patients (101 in LR group and 104 in TIPP) were included in the study. There were no differences in baseline characteristics and operative findings. Postoperative pain was lower for TIPP group (p 0.05). Follw-up was 98% at 1 month, 74% after 6 months and 64% after 1 year. Recurrence rate was higher for LR (p=0.027). Pain was increased in LR group. Conclusion: TIPP is equal in terms of chronic pain and recurrence for complex groin inguinal hernias.

Background: complex ventral hernia repair is a frequent and challenging topic. Reconstructive techniques are numerous but most of them are unable to achieve the goals of hernioplasty. Posterior component separation with transverses abdominis muscle release (TAR) is a novel approach that offers a solution for complex ventral hernias. Method The posterior rectus sheath is incised and the retrorectus plane is developed. In a modification of the Rives-Stoppa technique, the transversus abdominis is released medial to the linea semilunaris to expose a broad plane that extends from the central tendon of the diaphragm superiorly, to the space of Retzius inferiorly, and laterally to the retro-peritoneum. This preserves the neurovascular bundles innervating the medial abdominal wall. Mesh is placed in a sublay fashion above the posterior layer. In an overwhelming majority of patients, the linea alba is reconstructed, creating a functional abdominal wall with wide mesh reinforcement. Results: Between November 2014 and July 2016 we used this procedure in 24 patients (14 males) with large median ventral incisional hernias. The recurrence in various degrees was present in 18 patients (75%). The average size of the defect was 18,3 cm. in width (12 to 28 cm.). Five patients (21%) developed various wound complications requiring reoperation. Follow-up between 2 and 18 months (11,8 months) without recurrence. Conclusion TAR seems to be the "ideal" approach for complex hernias with good immediate outcomes.