Retrorectus Hernia Repair and Transversus Abdominis Release

Abstract

Complex ventral hernias demand a robust armamentarium of surgical techniques to allow for a tailored approach to each patient. Among the various options available to surgeons, retromuscular techniques have gained widespread adoption in the current surgical culture. Retrorectus ventral hernia repair, as originally described by Rives, Stoppa, and Wantz, allows for creation of a well-vascularized sublay space for mesh placement, although within the confines of the rectus sheath. Further advancements to retrorectus repair, specifically posterior component separation via transversus abdominis release (TAR), offer further improvements to retromuscular hernia repair while relying on the foundations of a tissue-based, tension-free hernia repair. TAR allows significant myofascial medialization to address wide hernia defects and associated loss of domain. Furthermore, TAR results in the creation of a large sublay space beyond the confines of linea semilunaris while preserving the perforating neurovascular bundles to the rectus abdominis. Both techniques provide surgeons versatile and durable repair techniques to address the most complex hernia scenarios.