Transversus abdominis release in the management of a large, chronic defect of the abdominal wall.

Abstract

Chronic defects and hernias of the abdominal wall are a common complication of repeated surgical procedures and/or their accompanying complications. Reconstruction of the abdominal wall is difficult in these defects/hernias and debates of an ideal method of treatment have not reached a conclusion. Primary suture is usually impossible. Onlay, inlay, sublay, underlay and IPOM plasty procedures have their limits and often lead to unsatisfactory results. CST (component separation technique) technique is a new therapeutic approach enabling a solution of large defects and hernias of the abdominal wall with very good short-term results. TAR (transversus abdominis release) is a posterior approach in CST. It releases transversus abdominis muscle (MTA) to mobilize the posterior sheath of the rectus abdominis muscle (MRA). TAR preserves MRA and its neurovascular bundle, creates a large space for mesh insertion and allows complex reconstruction of the abdominal wall. A 55-year-old patient underwent surgery for perforated diverticulitis of colon sigmoideum with diffuse peritonitis. Hartmans operation was performed. The patient was reoperated for colostomy necrosis and fascia dehiscence on the 7th postoperative day. After healing 6 months later, colostomy occlusion was indicated. The operation itself - colorectal anastomosis using an end-to-end circular stapler - was without complications. However, complications occurred in the postoperative period including an intra-abdominal abscess in the lesser pelvis and subsequent destructive phlegmona and necrosis of the abdominal wall, resulting in a non-healing extensive chronic abdominal wall defect. After the failure of conservative treatment, the chronic defect was excised and the abdominal wall was reconstructed using the TAR method. TAR is an acceptable method in the treatment of large defects and hernias of the abdominal wall, associated with low perioperative morbidity and low recurrence rates.