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PWE-410 Initial UK experience with transversus abdominus muscle release for posterior components separation in abdominal wall reconstruction of large or complex ventral hernias. a combined approach by general and plastic surgeons
  1. N Appleton1,
  2. K Anderson2,
  3. K Hancock2,
  4. M Scott3,
  5. C Walsh4
  1. 1Department of Surgery, Arrowe Park Hospital, Chester
  2. 2Department of Plastic Surgery
  3. 3Department of Surgery, Whiston Hospital, Whiston
  4. 4Department of Surgery, Arrowe Park Hospital, Wirral, UK

Abstract

Introduction Large complicated ventral hernias are an increasingly common problem following laparotomy and particularly laparostomy. Moreover, they are often seen in patients with significant co-morbidities who may have or need to have stomas. Repair with bridging is associated with high recurrence rates and makes surgical risk unattractive. The transversus abdominis muscle release (TAMR) is a recently described modification of posterior components separation for repair of such hernias. We describe our initial experience with TAMR and sublay mesh to facilitate abdominal wall reconstruction.

Method A retrospective review of consecutive patients undergoing TAMR performed synchronously by colorectal and plastic surgeons since June 2013.

Results Twelve consecutive patients had their ventral hernias repaired using the TAMR technique from June 2013 to June 2014. Median body mass index was 30.8 kg/m2(range 19.0–34.4 kg/m2). Four had a previous ventral hernia repair. Three had previous laparostomies. Four had previous stomas and three had stomas created at the time of the abdominal wall reconstruction. Average and range of transverse distance between the recti was 13 cm (3–20 cm). Median operative time was 383 min (range 150–550 min), and mesh size was 950 cm2(532–2400 cm2). Primary midline fascial closure was possible in all cases with no bridging. Median length of hospital stay was 7.5 days (4–17 days). Three developed minor abdominal wall wound complications. At short-term review (median 3.5 months), there have been no significant wound problems, no mesh infections or explants and none have developed recurrence of their ventral hernia.

Conclusion We believe TAMR offers significant advantages over other forms of components separation in this patient group. The technique can be adopted successfully in UK practice and combined gastrointestinal and plastic surgeon operating yields good early results.

Disclosure of interest None Declared.

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