Transversus abdominis release (TAR) is the newest approach that allows effective myofascial mobilization, creating a large retromuscular space and wide mesh overlap to repair complex and large incisional ventral hernias. This article narrates the technical details and results of the TAR technique performed in a single center. The present study is a retrospective analysis of a prospective dataset from 25 patients who underwent posterior component separation (PCS) with TAR procedure for large incisional ventral hernias between October 2017 and July 2021. The minimum follow-up period was ten months. Twenty-five patients (five male, 20 female) with a mean age of 61.2 years, a mean BMI of 32.2 kg/m2, and a median ASA score of 2.0 underwent the TAR procedure. Fifteen (60%) patients had a history of incisional hernia surgery. The mean surgical time was 248 minutes. The mean total defect and mesh areas were 187.4 (90-500) cm2 and 1141.8 (750-2250) cm2, respectively. The mean visual analog scale (VAS) pain score on the first postoperative day was 4.5 and the median hospital length of stay (LOS) was 5 days. There were three (12%) surgical site infections (SSIs), two of which were deep infections that needed debridement. During the follow-up period (median of 26 months), two (8%) recurrences were recorded. The TAR technique represents an effective and safe repair modality of large and complex incisional hernias. TAR is an essential addition to the repertoire of the surgical community.

Aim This study aimed to compare the outcomes of the eTEP-RS and IPOM-plus procedures in W1 and W2 midline incisional abdominal wall hernia (IAWH) repairs performed by the same surgeon. Material and Methods Prospectively collected data of laparoscopic abdominal wall repairs performed on 61 patients with eTEP between November 2018 and April 2022 and on 67 patients with IPOM-plus between January 2016 and April 2022 were retrospectively analyzed. A total of 74 out of 128 patients, 30 in the eTEP-RS group and 44 in the IPOM-plus group, who underwent W1-W2 midline incisional hernia repair were included in the study. The mean follow-up was 24 months in the eTEP-RS group and 45 months in the IPOM-plus group. Results There was no statistically significant difference between the groups regarding age, sex, BMI, ASA score, or active smoking. The mean mesh area (MMA) and mesh/defect (M/D) ratio were higher in the eTEP-RS group (p <0.001 and p =0.004). In the eTEP-RS group, the hospital length of stay (LOS) (1.48 days vs. 2.58 days, p <0.001) and pain on the first and 10th postoperative days were significantly lower (p <0.001), while the operative time was significantly longer (p <0.001). There was no significant difference in terms of intraoperative complications (p =0.56), seroma formation (p =0.83), or recurrence (p =0.83). Conclusions The eTEP-RS technique has advantages over the IPOM-plus approach, such as a shorter LOS and less early postoperative pain with W1-W2 midline IAWH repair. However, the eTEP technique has a longer operative time.