Laparoscopic transversus abdominis release for the treatment of complex ventral hernia

BACKGROUND: Posterior component separation through transversus abdominis muscle release (TAR) is an increasingly accepted technique worldwide for complex ventral hernia repair. Recently, researchers have attempted to perform the TAR procedure using minimally invasive approaches. In this study, we present our experience of laparoscopic TAR (Lap-TAR). The procedure will be described in detail and its feasibility evaluated. PATIENTS AND METHODS: To learn and be proficient in the procedure through soft cadaver workshop practice, we accumulated the necessary knowledge and minimally invasive surgery skills for the Lap-TAR procedure. We selected an appropriate patient and performed a Lap-TAR operation to treat complex ventral hernia. RESULTS: The Lap-TAR operation was successfully performed in a 73-year-old female patient with a giant lower abdominal incisional hernia, without open conversion. The estimated blood loss was 60 mL and the operative time was 365 min. The postoperative pain was mild, and the visual analog pain scale score was 3 on postoperative day (POD) 2. The patient was discharged on POD 7. All subfascial drains were removed before patient discharge. On an initial follow-up period of 3 months, there was no evidence of wound complication, bulging, or hernia recurrence. CONCLUSIONS: The Lap-TAR operation is technically feasible with a deliberate preparation. It could be an alternative for complex abdominal wall reconstruction with the potential to reduce pain, facilitate recovery, and decrease the length of hospital stay of patients.