Comparison of open anterior component and open transversus abdominus release in repair of large subcostal hernias

Abstract

Background Large subcostal incisional hernias are considered as complex defects, and a few different approaches have been described for repair. The purpose of this comparative cross-sectional study is to evaluate the outcomes of patients with large subcostal incisional hernias treated with either the open anterior components separation technique (ACS) or with the open transversus abdominis release technique (TAR). Methods From the database of patients with large complex incisional hernias who underwent abdominal wall reconstruction with open techniques between April 2007 and October 2022 at our institution, on May 25th, 2023 we identified those whose hernias were located in the subcostal areas and who underwent reconstruction with a components separation technique and mesh. Perioperative variables and outcomes were compared between the patients with large subcostal hernias who underwent abdominal wall reconstruction with either the ACS or the TAR techniques. Results Thirty-one patients with large subcostal hernias were included in the study. ACS and intra-abdominal mesh was used in 11 patients; TAR and retro-muscular mesh was performed in 20 patients. More postoperative local abdominal wall complications were seen in patients who had ACS as opposed to TAR (55% vs 15%, p = 0.02). Hernia recurrence was more common in patients who had ACS as opposed to TAR (55% vs 5%, p = 0.008). Conclusions More post-operative complications and recurrences were seen in patients who had ACS as opposed to TAR.

Contemporary Abdominal Wall Reconstruction: Emerging Techniques and Trends

“…While Krpata found that recurrence and wound complication rates favored PCS with TAR, open anterior patients had greater rates of pre-existing wound infections and diabetes which could have influenced the results [57]. While randomized controlled trials supporting this technique are not available, findings from multiple retrospective and prospective trials, systematic reviews, and meta-analyses have demonstrated the superiority of PCS with TAR in the repair of complex abdominal wall defects [57,[71][72][73].…”