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Case Series
Transversus abdominis release for difficult ventral hernias – An open challenge for open abdomen
1 Post Graduate Resident, Institute of Surgical Gastroenterology & Liver Transplant, Govt. Stanley, Medical College, Tamil Nadu, Chennai, India
2 Senior Assistant Professor, Institute of Surgical Gastroenterology & Liver Transplant, Govt. Stanley Medical College, Tamil Nadu, Chennai, India
3 Assistant Professor, Institute of Surgical Gastroenterology & Liver Transplant, Tamil Nadu, Chennai, India
4 Professor, Institute of Surgical Gastroenterology & Liver Transplant, Govt. Stanley Medical College, Tamil Nadu, Chennai, India
5 Professor & Head of Department, Institute of Surgical Gastroenterology & Liver Transplant, Govt. Stanley Medical College, Tamil Nadu, Chennai, India
Address correspondence to:
Sugi R. V. Subramaniam
601, Old Jail Road,Institute of Surgical Gastroenterology & Liver Transplant, Govt. Stanley Medical College, Chennai, Royapuram, Tamil Nadu,
600001 India
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Article ID: 100030S05SS2018
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Sugi RV, Senthil Kumar P, Prabhakaran R, Kamalakannan R, Saravanan J, Thiruvarul M, Sugumar C, Jeswanth S, Ravichandran P. Transversus abdominis release for difficult ventral hernias – An open challenge for open abdomen. Edorium J Surg 2018;5:100030S05SS2018.ABSTRACT
Massive incisional hernias and open abdomen are serious challenges which the patient and surgeon face. Even more complicated are non-midline hernias, parastomal hernias, hernias near bony landmarks, and recurrent ventral hernias especially after anterior component separation. The available reconstructive techniques may not be sufficient to tackle this large defect to re-establish the lost abdominal domain and to create a long lasting successful tension free repair. The traditional approaches are haunted by serious complications of wound infection, skin necrosis and high incidence of recurrences. Posterior component separation with transversus abdominis release is a recent innovation of Classic Stoppa’s repair that offers a durable solution to a variety of complex ventral hernias. We report our initial experience with two cases of incisional hernias post multiple laparotomies and large midline rectus defects. Both had an uneventful post-operative course and were discharged without any wound related complications. They are on regular follow up outpatient visits and no recurrences were reported till date. This novel approach of posterior component separation with transversus abdominis release proves to be safe, effective and durable technique for difficult abdominal closure which in future can reduce the incidence of open abdomen to bare minimum.
Keywords: Posterior component separation, Sublay mesh, Transversus abdominis release
SUPPORTING INFORMATION
Author Contributions:
Sugi R. V. Subramaniam - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Senthil Kumar Perumal - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Prabhakaran Raju - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Kamalakannan Rajendran - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Saravanan Janakiraman - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Thiruvarul Muthukumarasamy - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Jeswanth Sathyanesan - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Ravichandran Palaniappan - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this case series.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2018 Sugi R. V. Subramaniam et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
