title: Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction.
abstract: BACKGROUND
  Several modifications of the classic retromuscular Stoppa technique to facilitate dissection beyond the lateral border of the rectus sheath recently were reported. We describe a novel technique of transversus abdominis muscle release (TAR) for posterior component separation during major abdominal wall reconstructions.
  
  
  METHODS
  Retrospective review of consecutive patients undergoing TAR. Briefly, the retromuscular space is developed laterally to the edge of the rectus sheath. The posterior rectus sheath is incised 0.5-1 cm underlying medial to the linea semilunaris to expose the medial edge of the transversus abdominis muscle. The muscle then is divided, allowing entrance to the space anterior to the transversalis fascia. The posterior rectus fascia then is advanced medially. The mesh is placed as a sublay and the linea alba is restored ventral to the mesh.
  
  
  RESULTS
  Between December 2006 and December 2009, we have used this technique successfully in 42 patients with massive ventral defects. Thirty-two (76.2%) patients had recurrent hernias. The average mesh size used was 1,201 ± 820 cm(2) (range, 600-2,700). Ten (23.8%) patients developed various wound complications requiring reoperation/debridement in 3 patients. At a median follow-up period of 26.1 months, there have been 2 (4.7%) recurrences.
  
  
  CONCLUSIONS
  Our novel technique for posterior component separation was associated with a low perioperative morbidity and a low recurrence rate. Overall, transversus abdominis muscle release may be an important addition to the armamentarium of surgeons undertaking major abdominal wall reconstructions.
authors.affiliation: Department of Surgery, University of Connecticut Health Center, Farmington, CT, USA. yuri.novitsky@uhhospitals.org
authors.forename: Yuri W
authors.initials: YW
authors.lastname: Novitsky
authors.forename: Heidi L
authors.initials: HL
authors.lastname: Elliott
authors.forename: Sean B
authors.initials: SB
authors.lastname: Orenstein
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rosen
mesh_terms: D000009:Abdominal Muscles / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000209:etiology / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000628:therapy; D016896:Treatment Outcome