title: Transversus abdominis muscle release for repair of complex incisional hernias in kidney transplant recipients.
abstract: BACKGROUND
  Incisional hernias in kidney transplant recipients (KTRs) can be complex because of adjacent bony structures, proximity of the allograft/transplant ureter, and context of immunosuppression. We hypothesized that our novel posterior component separation with transversus abdominis muscle release (TAR) and retromuscular mesh reinforcement offers a safe and durable repair.
  
  
  METHODS
  KTRs with incisional hernias repaired using the aforementioned technique were identified within our prospective database (2007 to 2013) and analyzed.
  
  
  RESULTS
  Eleven patients were identified (median age 49 years, body mass index 32). The median hernia size was 30 cm(2) (range 88 to 1,040 cm(2)) and 8 of the 11 patients were recurrent. Intraoperative morbidity consisted of one transplant ureter injury repaired primarily over a stent. Postoperative morbidity consisted of 2 superficial surgical site infections that resolved and 1 readmission for a blood transfusion. There were no instances of mesh infection, explantation, graft loss, or graft dysfunction. With a median follow-up of 12 months (range 3 to 69), 1 (9%) lateral recurrence has been documented.
  
  
  CONCLUSIONS
  For complex incisional hernias in KTRs, TAR is associated with low perioperative morbidity and durable repair.
authors: Division of Transplant Surgery, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Cleveland, OH 44106, USA. Electronic address: Clayton.Petro@UHhospitals.org.
authors: Clayton C
authors: CC
authors: Petro
authors: Division of Transplant Surgery, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Cleveland, OH 44106, USA.
authors: Sean B
authors: SB
authors: Orenstein
authors: Division of Transplant Surgery, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Cleveland, OH 44106, USA.
authors: Cory N
authors: CN
authors: Criss
authors: Division of Transplant Surgery, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Cleveland, OH 44106, USA.
authors: Edmund Q
authors: EQ
authors: Sanchez
authors: Division of Transplant Surgery, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Cleveland, OH 44106, USA.
authors: Michael J
authors: MJ
authors: Rosen
authors: Division of Transplant Surgery, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Cleveland, OH 44106, USA.
authors: Kenneth J
authors: KJ
authors: Woodside
authors: Division of Transplant Surgery, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Cleveland, OH 44106, USA.
authors: Yuri W
authors: YW
authors: Novitsky
mesh_terms: D000009:Abdominal Muscles / Q000601:surgery*; D000328:Adult; D000368:Aged; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D012189:Retrospective Studies; D013526:Surgical Mesh
keywords: Abdominal wall reconstruction; Flank hernia; Kidney transplant; Posterior component separation; Transversus abdominis release; Ventral hernia