Linea Alba Research Articles

Original kinesio tape application for temporary diastasis recti reduction: a single case study

Background/Aims The person in this case study was a man with prostatic cancer and diastasis rectus abdominis. Perineal rehabilitation was needed to prevent urinary incontinence, before and after a radical prostatectomy. This study reports on an original application of kinesio tape to reduce the diastasis rectus abdominis so that he could carry out the rehabilitation programme. Methods Three green-coloured Y-type tapes (width 5 cm and length 15 cm) were positioned to form an X, orthogonally at the linea alba, separating the tape half in width and two-thirds of a grid in length into 2 ends, under 75% pulling force (above and below the navel), and two green-coloured I-type tapes (width 5 cm and length 30 cm) positioned in parallel at the rectus abdominis, from the external face of the 5th, 6th and 7th costal cartilage and by the xiphoid process to the upper part of the pubis tubercle and pubic symphysis under 50% pulling force. Kinesio tapes were applied daily before every session of the perineum rehabilitation. Findings A significant reduction of the diastasis was observed by ultrasound, after the kinesio tape was applied. Conclusions This case demonstrates that it was possible to perform a pre- and post-operative perineal rehabilitation programme after the application of kinesio tape, which efficiently reduced the diastasis rectus while performing exercises, with the aim to prevent urinary incontinence.

Diastasis Recti Abdominis-diagnosis, Risk Factors, Effect on Musculoskeletal Function, Framework for Treatment and Implications for the Pelvic Floor

Background:Diastasis Recti Abdominis (DRA) can occur during pregnancy and postpartum. It is defined as an increase of the inter-recti distance (IRD) beyond normal values. The diagnosis of DRA is inconsistent within the literature and varies depending on measurement instrument and activity during measurement (rest versus active curl-up). DRA is characterized by the stretching of linea alba (LA) and contributes to a protrusion of the anterior abdominal wall due to increased laxity in the myofascial system that supports abdominal viscera. DRA has been postulated to affect lumbopelvic support and function due to laxity of the LA and altered angle of muscle insertion, but recent studies have not confirmed this. Risk factors for the development of DRA have been investigated in pregnancy to 12-months postpartum.Objective:Rehabilitation for DRA has been traditionally focused on reducing the IRD, but recent research has proposed that a sole focus on closing the DRA is suboptimal.Results:It is important alongside the rehabilitation of the abdominal wall that there is the consideration of the pelvic floor (PF). In healthy individuals, with the activation of the transversus abdominis, there is a sub-maximal co-contraction of the PF muscles. This co-contraction can be lost or altered in women with urinary incontinence. An increase in intra-abdominal pressure without simultaneous co-contraction of the PF may cause caudal displacement of the PF.Conclusion:The aim of this review is to bring the reader up to date on the evidence on DRA and to propose a rehabilitation framework for the whole abdominal wall in DRA with consideration of the impact on the PF.

Classification of Rectus Diastasis-A Proposal by the German Hernia Society (DHG) and the International Endohernia Society (IEHS).

Introduction: Recently, the promising results of new procedures for the treatment of rectus diastasis with concomitant hernias using extraperitoneal mesh placement and anatomical restoration of the linea alba were published. To date, there is no recognized classification of rectus diastasis (RD) with concomitant hernias. This is urgently needed for comparative assessment of new surgical techniques. A working group of the German Hernia Society (DHG) and the International Endohernia Society (IEHS) set itself the task of devising such a classification.Materials and Methods: A systematic search of the available literature was performed up to October 2018 using Medline, PubMed, Scopus, Embase, Springer Link, and the Cochrane Library. A meeting of the working group was held in May 2018 in Hamburg. For the present analysis 30 publications were identified as relevant.Results: In addition to the usual patient- and technique-related influencing factors on the outcome of hernia surgery, a typical means of rectus diastasis classification and diagnosis should be devised. Here the length of the rectus diastasis should be classified in terms of the respective subxiphoidal, epigastric, umbilical, infraumbilical, and suprapubic sectors affected as well as by the width in centimeters, whereby W1 < 3 cm, W2 = 3− ≤ 5 cm, and W3 > 5 cm. Furthermore, gender, the concomitant hernias, previous abdominal surgery, number of pregnancies and multiple births, spontaneous birth or caesarian section, skin condition, diagnostic procedures and preoperative pain rate and localization of pain should be recorded.Conclusion: Such a unique classification is needed for assessment of the treatment results in patients with RD.

Colopexy dehiscence preceding an episode of large colon volvulus, followed by repeat colopexy, in three Thoroughbred broodmares

SummaryThree Thoroughbred mares that had undergone previous colopexy following surgical correction of a large colon volvulus presented for colic signs unresponsive to medical management. Exploratory laparotomy was elected and a midline celiotomy was performed in the caudal aspect of the ventral abdomen in each mare. Examination of the cranial abdomen revealed the large colon was not adhered to the ventral body wall, indicating dehiscence of the previous colopexy. Further examination of the abdomen in each mare revealed a 360‐degree large colon volvulus. The previous colopexy site appeared as a linear haemorrhagic area of fibrosis in one mare and a pale area of fibrosis in two mares. The large colon volvulus was corrected and a second colopexy was then performed using the same technique as the first colopexy – by incorporating 10–12 cm of the lateral free band of the left ventral colon into the midline linea alba closure using number 3 polyglactin 910 (Vicryl®). The mares each recovered uneventfully from anaesthesia and were discharged 2–10 days later. Two of the mares are still alive at the time of manuscript submission, 475 and 789 days post‐operatively. The third mare survived 4 years post‐operatively, following which she was lost to follow‐up. Data available from our clinic indicate an incidence rate of 0.79% for colopexy dehiscence followed by a repeat episode of large colon volvulus. This phenomenon should be considered as a differential diagnosis when a mare that previously underwent a colopexy presents with severe signs of colic.

Anatomical study comparing medialization after Rives-Stoppa, anterior component separation, and posterior component separation

Large incisional hernias require medialization of the rectus abdominis muscles to facilitate tension-free closure. Medialization may be achieved by Rives-Stoppa, anterior component separation, or posterior component separation. This study aims to compare medialization achieved by these techniques in postmortem human specimens. First, the Rives-Stoppa procedure was performed. Subsequently, anterior and posterior component separation were performed on one side in each specimen, with each specimen functioning as its own control. Medialization was measured at three levels of the linea alba with three 1-kg weights. Both medialization obtained in addition to initial medialization after opening the linea alba and total medialization were measured. Results are presented as median and interquartile range. A total of 13 postmortem human specimens were included (Rives-Stoppa n = 13, component separation n = 10). Additional medialization after Rives-Stoppa was 1.2 cm (IQR: 0.3-2.2) for the anterior rectus sheath and 2.2 cm (IQR: 1.6-3.0) for the posterior rectus sheath (total medialization: 3.9 and 4.5 cm). For the anterior rectus sheath, additional medialization was 2.6 cm (IQR: 1.2-3.6) after anterior component separation and 1.9 cm (IQR: 0.4-3.4) after posterior component separation (P = .125, total medialization: 6.5 and 5.7 cm). For the posterior rectus sheath, additional medialization was 3.0 cm (IQR: 2.2-3.7) after anterior component separation and 5.2 cm (IQR: 4.2-5.9) after posterior component separation (P < .001, total medialization: 5.8 and 9.4 cm). Posterior component separation yielded significantly more medialization of the posterior rectus sheath compared with Rives-Stoppa and anterior component separation. Anterior component separation may provide marginally more medialization of the anterior rectus sheath.

The effects of the muscular contraction on the abdominal biomechanics: a numerical investigation

Abdominal wall biomechanics is strongly affected by muscular contraction and intra-abdominal pressure (IAP) which characterize different physiological functions and daily tasks. However, the active muscular behavior is generally not considered in current computational models of the abdominal wall. The aim of this study is to develop a numerical model mimicking muscular activation and IAP.A three dimensional Finite Element model of a healthy abdominal wall is developed detailing the principal abdomen components reconstructed upon anatomical data and medical images. Fascial tissues, aponeuroses and linea alba are modelled as hyperelastic fiber-reinforced materials, while a three-element Hill’s model is assumed for muscles. Numerical analyses are performed increasing the IAP up to 100 mmHg and simultaneously activating the muscular structures.The obtained abdominal behavior is compared to a similar model with same IAPs, but passive muscles conditions. Abdomen stiffness and strength are computed in regions in which hernias can potentially occur. A global stiffening of the abdominal wall is found corresponding to a low abdomen deformation and the membrane force on fascial structures is reduced by muscular contraction.Representing active muscular contraction leads to advanced findings, otherwise membrane force results overestimated considering a purely passive behavior for the abdominal wall.

The use of self-gripping mesh with anterior component separation technique in incisional hernia repair: A case series

IntroductionIncisional hernia (IH) is a common postoperative complication that affects 10% of the patients who undergo abdominal surgery. The component separation (CS) technique is suitable for large and/or complex hernias; however, CS alone may not eliminate recurrence and is associated with an increased incidence of wound complications. Self-gripping mesh enhances tissue adhesion and contributes to a reduced risk of migration, chronic pain, and other complications. Here, we present three cases of IH that were successfully repaired by anterior CS (ACS) using onlay self-gripping meshes. Case presentationAll three patients underwent surgery using the following technique: Briefly, a skin flap was created with release of the external oblique muscle and preservation of the perforating vessels. The linea alba was closed with absorbable interrupted sutures. A self-gripping mesh was trimmed and placed with a 4–5 cm overlap bilaterally from the closed linea alba using an onlay technique. For all patients, the postoperative courses were uneventful and there were no complications at the 3-month follow-up. DiscussionThe advantages of our technique include more sufficient abdominal reinforcement, technical simplicity, and minimal time required for mesh placement. The disadvantages are the potential risk of decreased blood flow of the skin flaps, wound infection, intestinal fistula, persisting or chronic pain, and difficulty with subsequent abdominal surgery. ConclusionThe use of self-gripping mesh with ACS can be performed without increasing the operative time or causing short-term surgical complications. This technique may be recommended for large IH because of its simplicity and secure abdominal reinforcement provided.

Single-incision laparoscopic approach for linea alba hernia in children.

Objective:The aim of this study is to describe the technique and to evaluate the outcome of single-incision laparoscopic (SILC) approach for linea alba hernia in children.Materials and Methods:A 2 cm vertical umbilical incision was made and stretched horizontally. A 5-mm trocar was inserted through middle port for the telescope. Another extra-long 5-mm 30° trocar was inserted through the lateral port, 5 mm beside the middle port. The extraperitoneal fat was removed, and the defect of linea alba was repaired after hernial sac was excised. The peritoneum was reconstructed with interrupted suture.Results:From May 2014 to May 2015, eight children with linea alba hernia underwent SILC. Pre-operative abdominal ultrasound showed the average diameter of hernia ring was 3.2 ± 0.7 cm. Mean operation time was 32.5 min (range = 30–45 min). Oral intake was resumed during anaesthesia recovery period. All could endure pain and discharge on the post-operative 12 h. There was no post-operative wound infection. The follow-up period was 1–12 months, no recurrence and other complications occurred.Conclusions:SILC approach for linea alba hernia is a safe and effective, minimally invasive new technology. The linea alba hernia could be repaired with a cosmetic outcome.

Extended totally extraperitoneal repair (eTEP) for ventral hernias: Short-term results from a single centre

Introduction:There has been a surge of innovative procedures in the field of abdominal wall hernias. Works of pioneers such as Dr. Yuri Novitsky, Dr. Jorge Daes and Dr. Igor Belyansky have started a new era in the field of hernia surgery. Conventional and popular surgeries for ventral hernias are open onlay mesh hernioplasty, open retromuscular mesh hernioplasty (Rives-Stoppa procedure) and laparoscopic intraperitoneal mesh hernioplasty. Evidence seems to suggest that retromuscular mesh hernioplasty has advantages over other procedures regarding recurrence and surgical site occurrences. An alternative strategy has been developed for this setting where a mesh is placed in retromuscular space by minimal access technique of the extended Totally Extraperitoneal approach (eTEP).Methods:We have retrospectively analysed the data of 21 patients who underwent an eTEP procedure with a minimum follow-up of 2 months. Their data were analysed for operative details, intra-operative and post-operative complications.Results:For a total of 21 patients, we have recorded a total of two surgical site occurrences (1 seroma and 1 linea alba dehiscence) and one recurrence. One patient had chronic pain. There was no surgical site infection.Conclusion:Judging from our short-term results, we suggest that the eTEP technique can be adapted in centres with advanced laparoscopic skills with the careful patient selection.

Ultrasonographic evaluation of the linea alba before and after laparotomy in horses

Ultrasonographic evaluation of the linea alba before and after laparotomy in horses

Case series of a novel open plication supported by mesh (PSUM) - technique for symptomatic abdominal rectus diastasis repair with or without concomitant midline hernia: Early results and a review of the literature

BACKGROUND: Abdominal rectus diastasis (ARD), sometimes combined with abdominal wall midline hernia, is a common complaint in women after childbirth. To some individuals, ARD causes functional disability. Convincing data of the long-term results of ARD repair are lacking, especially when ARD is severe, and the optimal technique is undefined. In plastic surgery, the repair is often done with suture alone, but if a concomitant hernia exists, using a mesh is mandatory. This paper reports a novel surgical technique aimed at a reliable and minimally traumatic repair of ARD with or without midline hernia and a review of the literature of ARD repair. PATIENTS AND METHODS: During June 2013–April 2018, 37 consecutive patients with symptomatic ARD with or without concomitant midline hernia were operated on by using a narrow piece of a self-gripping mesh (n = 32) or the tails of the ventral patch (n = 5). The mesh was placed in between the plicated linea alba. The outcome and patient satisfaction in this pilot study were analyzed. RESULTS: A significant subjective improvement in body balance after surgery was reported by 34 patients (92%). During the mean follow-up of 13 months, there was only one partial recurrence of ARD. The complication rate was low, and patient satisfaction was good. CONCLUSION: According to the present study, selected patients with severe lack of muscle control and/or back pain benefit from ARD repair. The minimally traumatic PSUM mesh augmentation seems a promising method for the repair of ARD.

Retromuscular Approach in Ventral Hernia Repair - Endoscopic Rives-Stoppa Procedure.

Introduction: In 1993 Leblanc published his laparoscopic technique in ventral hernia repair. The procedure has been improved due to deeply change of the paradigm in abdominal wall reconstruction. Placing the mesh into the retrorectus space was initially a big challenge but now the Rives-Stoppa procedure by endoscopic approach extended total extra-peritoneal approach (eTEP) become a well known technique. Method: The total extraperitoneal (TEP) approach used in inguinal hernia repair, is extended cranially into the rectus sheath. Crossover the midline toward the contralateral retrorectus space, being outside the peritoneal cavity, allows bilateral retrorectus dissection, reducing the hernia, restoring the linea alba and placing a polypropylene mesh under the rectus muscles. Results: I applied this technique between 2016 June 2017 December in 63 cases in ventral (primary or incisional) hernia repair having median area 60 sqcm (6 - 300). To close the defect and restore linea alba it was necessary to perform TAR in 19 cases. Median hospitalisation was 1day (1 9). Follow up at 2, 6, 12 months: 1 case with chronic pain and no recurrences until now. Conclusions: Combining the advantages of the Rives-Stoppa procedure with the the advantages of minimally invasive surgery (MIS), the eTEP approach tends to occupy an important place in ventral hernia repair.

The Relation between the Distance of Recto-Fascial Plication and the Intra-Abdominal Pressure Changes before and Immediately after Abdominoplasty

Background: Abdominoplasty surgery involves excisionof redundant abdominal skin flap and, in most cases, involvesrestoring weakened anterior abdominal wall muscles creatingan abdominal profile that is smoother and firmer. Diastasisrecti caused by anterior abdominal wall weakness. It happensbecause the space between left and right recti muscles hasbeen widened. Surgical correction for diastasis during theabdominoplasty can be considered as a definitive way forcorrection of diastasis by performing a plication or foldingof the linea alba, this results in a tighter abdominal wall.Aim of Work: Is to evaluate the relationship between thedistance of recto-fascial plication and intra-abdominal pressure(IAP) changes before and immediately after abdominoplasty.Patient and Methods: This study included 75 femalepatients, ageing between 24-57 years old, with mean age of43.3 years. Patients complained of abdominal redundancyafter childbirth, or post massive weight loss, with weak anteriorabdominal wall muscles. The diastasis width was measuredintraoperatively at three levels (3cm above the umbilicus, atthe umbilicus, and 3cm below the umbilicus) before performingrecto-fascia plication. Recto-fascial plication have beenperformed for all patients during their abdominoplasty procedurein two layers. Intra-abdominal pressure (IAP) variation,before and immediately after rectus sheath plication weremeasured using U-tube technique. Statistical analysis of allmeasurements were done.Results: Statistical analysis showed that the mean valueof diastasis above and at the umbilicus didn't differ significantly,however it was significantly lower below the umbilicuscompared with the other two levels. Comparing the pre andpostoperative IAP showed non-statistically significant increaseof IAP postoperative. Most importantly, statistics showed thatthere is a statistically significant positive correlation betweenthe IAP immediately after surgery and the distance of rectofascialplication especially above the umbilicus. Complicationrate in the current study was 2.6%.Conclusion: As a result of our current study, rectus diastasiswidth is significantly correlated with the IAP immediatelyafter abdominoplasty, therefore the larger the width of therectus diastasis, the more increase of IAP that would happenimmediately after abdominoplasty.

Clinical efficacy of laparoscopic-assisted linea alba reconstruction for postpartum diastasis recti

Objective To investigate the clinical efficacy of laparoscopic-assisted linea alba reconstruction for postpartum diastasis recti. Methods The retrospective cross-sectional study was conducted. The clinical data of 14 patients with postpartum diastasis recti who were admitted to Ruijin Hospital of Shanghai Jiaotong University School of Medicine between June 2016 and June 2018 were collected. Patients underwent laparoscopic-assisted linea alba reconstruction. Observation indicators: (1) intra- and post-operative recovery situations; (2) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect postoperative long-term complications, diastasis recti and umbilical hernia recurrence up to September 2018. Measurement data with normal distribution were represented as ±s and measurement data with skewed distribution were described as M(P25, P75). Results (1) Intra- and post-operative situations: 14 patients underwent successful laparoscopic-assisted linea alba reconstruction and 8 complicated with umbilical hernia area of (6±3)cm2 were sutured and closed. The mesh area, operation time, visual analogue score for pain at the first day after operation, time of postoperative drainage-tube removal and duration of postoperative hospital stay were respectively (214±26)cm2, (74±14)minutes, 3.7±0.6, (3.3±0.7)days and (4.1±1.2)days. No patient required administration of analgesics and had postoperative complication. (2) Follow-up: 14 patients were followed up for 17 months (5 months, 21 months). During the follow-up, 1 patient returned visit at postoperative day 10 due to surgical incision drainage and cured after dressing change. The other patients had no complications, without diastasis recti and umbilical hernia recurrence. Conclusion Laparoscopic-assisted linea alba reconstruction for postpartum diastasis recti is safe and effective. Key words: Diastasis recti, postpartum; Linea alba reconstruction; Mesh repair; Laparoscopy; Complications; Recurrence

Bone morphogenetic protein-12 inducing tenogenic differentiation of mesenchymal stem cells enhances healing of linea alba incision.

The objective of this study was to investigate the curative effects of mesenchymal stem cells' tenogenic differentiation on linea alba incision healing induced by bone morphogenetic protein-12. Mesenchymal stem cells were isolated and induced by 10 ng/ml of bone morphogenetic protein-12 for 48 h. Expression of scleraxis, collagen I and collagen III were examined at 48 h, 5 and 7 days to investigate the tenogenic differentiation. The expression of scleraxis increases continually even in the absence of bone morphogenetic protein-12 for 5 days (P<0.01). The expression of collagen I and III requires persistent inducing. Then fifty Sprague-Dawley rats were randomly divided into five groups: negative control, positive control, sham group, native mesenchymal stem cells and tenogenically differentiated mesenchymal stem cells. Tensiometric testing and modified semiquantitative histological analysis were performed to explore the curative effects. The tension levels in the positive control, sham, native mesenchymal stem cells and tenogenically differentiated mesenchymal stem cells were 44, 41.8, 51.6 and 69.7%, respectively, compared with the negative control. Tenogenically differentiated mesenchymal stem cells exhibited a greater increase in tension compared with positive control, sham and native mesenchymal stem cell groups (P<0.05). From the sections stained with Masson's Trichrome, collagen organization and amount of tenogenically differentiated mesenchymal stem cells was better than the other three groups (P<0.05). In conclusion, mesenchymal stem cells' tenogenic differentiation induced by bone morphogenetic protein-12 can enhance linea alba incision healing.

Epidemiology of oral mucosal lesions in Slovenia.

BackgroundAmong the diseases of oral mucosa, malignant tumors are the most dangerous, but not the most common lesions that might appear in the oral cavity. Since most of the studies are focused on the detection of cancer in the oral cavity, we were interested in detecting the frequency of benign changes of the oral mucosa in Slovene population. Oral mucosal lesions are important pointer of oral health and quality of life, especially in elderly. The prevalence of oral mucosal lesions, together with information on the risk habits associated with oral health, such as tobacco and alcohol use, can help in planning future oral health studies and screening programs.Patients and methodsSurvey upon oral mucosal lesions was conducted during the national project for oral cancer screening in spring 2017 in the Slovenia in which more than 50% of dentists participated and 2395 patients (904 men and 1491 women) were included.ResultsClinical examination, which was conducted according to the WHO standards revealed that 645 patients (27%) had oral mucosal lesions. The ten most common oral lesions detected were fibroma, gingivitis, Fordyce spots, white coated tongue, cheek biting, linea alba, denture stomatitis, geographic tongue, recurrent aphthous ulcerations and lichen planus.ConclusionsOverall, these epidemiological data suggest need for specific health policies for prevention, diagnosis and treatment of oral mucosal lesions.

A Current Review of Synthetic Meshes in Abdominal Wall Reconstruction.

The use of mesh materials for reinforcement of the abdominal wall has revolutionized the approaches to hernia repair. Whether it's a permanent, synthetic mesh, a biologically derived collagen graft, or a synthetic, bioresorbable construct, data demonstrate improved outcomes with respect to recurrence with their use. Numerous advances and development of component separation techniques of the abdominal wall musculature have provided surgeons the ability to close large fascial defects and reestablish the linea alba for midline hernias. Augmentation of the these repairs with a mesh helps to offset the tension on the fascial closure and provide biomechanical strength to the native tissue. However, the use of mesh materials as either permanent or temporary scaffolds is not without potential complications. Abdominal wall surgeons must have knowledge of the mesh composition and structure in an effort to mitigate these concerns. This chapter will review the polymers and characteristics of the currently available synthetic meshes for abdominal wall reconstruction in an effort to provide guidance to surgeons.

Successful surgical treatment of abdominal compartment syndrome in patient with pancreatic necrosis

Case report of patient with severe autonomous advanced pancreatic necrosis followed by compartment syndrome is presented. Augmentation of intra-abdominal pressure from 18 to 30 mm Hgwas accompanied by aggravation of respiratory, renal and intestinal insufficiency. Urgent video-assisted fasciotomy was applied with dissection of linea alba while peritoneum was preserved. Postoperative period was characterized by reduced intra-abdominal pressure followed by its normalization after 24 hours. Favorable clinical effect was achieved. Subsequent medication was able to avoid surgery and minimally invasive procedures. Patient was discharged after 28 days.

How I Do It: New Dissector Device Allows for Effective Operative Field in Transoral Endoscopic Thyroid Surgery Using Vestibular Approach.

Minimally invasive thyroid and parathyroid resections are rarely performed. Promising new endoscopic transoral approaches to the anterior neck (transoral endoscopic thyroidectomy vestibular approach [TOETVA]) have been described with good results and few complications. This study evaluates a new device to allow the safe entrance of trocars in the subplatysmal space for TOETVA in a cadaver model. The technique was performed in 4 unilateral thyroidectomies in female cadavers. The technical steps consisted of a 10-mm incision made at the center of the oral vestibule followed by subplatysmal hydrodissection. The blunt dissector is a metallic stick with an olive at the end and promotes progressive gain in subplatysmal space enlarging the operative field. The instrument was inserted creating a space below the platysma to the anterior neck and the strap muscles. Three trocars were inserted in the vestibular area. The dissection begins by cutting the linea alba cervicalis. The isthmus was dissected and transected. Anatomical structures as the superior thyroid artery, parathyroid glands, and the recurrent laryngeal nerve could be safely identified with magnified vision. Optimal operative field due to subplatysmal dissection by the device allowed for exposition of thyroid and parathyroid glands in all cases. Unilateral thyroidectomy was performed in a mean of 54 minutes with excellent aesthetic results. The new device is a promising feature to allow safe transoral thyroid surgery in a cadaver model. Further studies in clinical series are needed to evaluate the broad application of the device.

Posterior component separation by transversus abdominis release-current paradigm in management of large complex hernias: Our initial experience

BackgroundRepair of large complex ventral hernia repair presents many difficulties to the hernia surgeon owing to large wide defects that are difficult to appose in the midline. PCS- TAR is one novel reconstructive technique that addresses the goals of hernia repair without tension and placement of extraperitoneal large mesh without tension. MethodThe retrorectus plane is entered by incising the posterior rectus sheath as in the modified Rives-Stoppa technique, the transversus abdominis muscle is released at its attachment medial to the linea semilunaris. This plane is dissected laterally to the psoas muscle in the retro-peritoneum preserving the neurovascular bundles supplying the recti. A large polypropylene mesh is placed with a large overlap. The posterior sheath and the linea alba is reconstructed in the midline creating a functionally physiological abdominal wall. ResultsOur patient was a 62 year old lady with a BMI of 29 with a large incisional hernia following multiple surgeries and loss of domain. The size of the defect was 7 × 8 cm in the midline with another defect laterally. PCS- TAR was performed under General anaesthesia and took slightly more than 4 h. There were no intraoperative complications. Follow-up at 5 weeks showed no wound infection, seroma or recurrence. ConclusionTAR is a novel but effective technique in dealing with large complex hernias with loss of abdominal domain and gives good postoperative outcomes.