Comparison between transversus abdominis release and anterior component separation technique in complex ventral hernia

Abstract

INTRODUCTION: Transversus abdominis release (TAR) is the new revolution in hernia surgery and hernia surgeons are passionately doing it all over the world. With the increase in the popularity of TAR technique, there seems a decrease in anterior component separation technique (ACST) popularity. ACST despite gone modification such as endoscopic and perforator preserving method is seen as an inferior procedure to TAR. Is TAR better than ACST? What are its theoretical limitations? We have done a literature review to compare the postoperative outcomes and technicality of open ACST and open TAR procedure. METHODS: We performed a search in the database of PubMed, EMBASE, and Cochrane library for articles that have compared ACST with TAR procedure for postoperative outcomes and technical superiority. The search was limited to human studies and in the English language with cadaveric studies included. RESULTS: We found seven studies that have compared ACST and TAR for various outcomes. They are three systemic reviews with meta-analysis, one multicentric prospective randomized controlled trial, one prospective study, and two cadaveric studies. They have compared the surgical site infection and surgical site occurrence rates, recurrence rate, quality of life (QOL), and extent of mobilization of the rectus muscle. Most of the studies found no significant difference between ACST and TAR; however, the overall quality of the studies may be limited. CONCLUSION: Open ACST is comparable to open TAR procedure and has equally acceptable outcomes. In ACST, it seems to be essential to preserve the perforator vessels; however, altogether further studies are needed to gain more clarity in the daily decision-making process in the repair of complex ventral hernias.