Surgical “error traps” of open posterior component separation—transversus abdominis release

Abstract

Past techniques for the repair of complex incisional hernias have been met with unacceptably high recurrence rates and postoperative complications. The transversus abdominis release (TAR) is a versatile and durable solution gaining popularity amongst both abdominal wall specialists and general surgeons. However, several preoperative factors and specific intraoperative pitfalls can have a major impact on patient outcomes. The authors review the current literature and draw upon their own practice experience to highlight key preoperative and perioperative steps for avoiding common pitfalls or "error traps" often performed by a surgeon new to this surgical technique. We discuss preoperative factors that influence the outcomes of patients undergoing incisional hernia repair. We show how a TAR that preserves the neurovascular bundles supplying the rectus complex and dissection in the correct plane prevents the formation of new, challenging unintended hernia defects and provides for wide prosthetic overlap offering the patient a sustainable repair. Lastly, we highlight key postoperative factors that affect a patient's recovery. Avoidance of surgical error traps combined with technique mastery can lead to the successful repair of challenging abdominal wall defects using the TAR approach.