P-004 OUR EXPERIENCE WITH POSTERIOR COMPONENT SEPARATION – TAR (TRANSVERSUS ABDOMINIS RELEASE) IN LARGE COMPLEX INCISIONAL HERNIAS – A SERIES OF 18 PATIENTS

Abstract

Abstract Background Large incisional hernias represent a challenge for parietal surgeon. Thanks to the modification of the Rives-Stoppa technique introduced by Novitsky, a new era in solving complex defects begun. Posterior component separation (PCS) with unilateral/bilateral TAR has promising results in many studies. Our experience is presented in a retrospective study. Method We present a study on 18 patients (sex ratio=1:1), operated between 2019–2022, with large complex incisional hernias. Mean body mass index was 37.17 kg/m2 (range 31–42). Mean age – 58 years (range 34–70 years). We used PCS with bilateral TAR in 12 cases (66.66%) and unilateral TAR in 6 cases. One of the hernias was a combined midline-large parastomal hernia operated using Pauli technique. 5 of the hernias (27.78%) were lumbar, of which 2 were operated with hybrid technique (open and laparoscopic), using reverse TAR. Mesh used was polypropylene (61.11%) and ePTFE mesh (38.89%). The prothesis size ranged from 20×25 cm to 34×32 cm. Mean operative time was 3.41 hrs (range 2–4 hrs). Average hospitalization time was 5.44 days (range 2–14 days). Results Fascial closure anterior to mesh was achieved in 72.22% of patients. No recurrences were reported in the follow-up (3–12 months). Postoperative morbidity: seromas (33.33%), wound infection (11.11%), hematoma (5.55%). Conclusions Rives-Stoppa technique is the gold standard in VHR. Extending this technique with PCS-TAR in complex incisional hernias seems to be the perfect solution in obese patients with great outcome and low postoperative morbidity. Also the hybrid approach has great results and we hence recommend.