Outcomes of transversus abdominis release (TAR) with permanent synthetic retromuscular reinforcement for bridged repairs in massive ventral hernias: a retrospective review.

ABSTRACT

PURPOSE: In a subset of patients with massive and multiply recurrent hernias, despite performing a transversus abdominis release (TAR), anterior fascial re-approximation is not feasible and a bridged repair is required. We aim to report on the outcomes of this patient population at our institution. METHODS: Patients that underwent a TAR-bridged repair at the Cleveland Clinic were identified retrospectively within the Americas Hernia Society Quality Collaborative (AHSQC) database. Outcomes of interest were quality-of-life metrics measured through HerQLes and PROMIS pain intensity 3a and composite recurrence measured by patient-reported outcomes, physical examination, or CT imaging. RESULTS: Ninety-six patients met inclusion criteria. The mean hernia width was 26 ± 8 cm. The majority (93%) were incisional hernias and 71% were recurrent with 21% having five prior hernia repairs. Of those eligible for recurrence and QoL analysis, 54 (70%) had data points available. HerQLes scores showed a steady improvement throughout postoperative recovery (26 ± 21 at baseline, 44 ± 26 at 30-day follow-up, and 60 ± 33 at 6 months-3 years; P < 0.001), as did the PROMIS Pain Intensity 3a scores (46 ± 11 at baseline, 45 ± 11 at 30-day follow-up, and 39 ± 11 at 6 months-3 years; P = 0.001). At a mean follow-up of 20 ± 10 months, a composite recurrence of 46% was reported, primarily from patients reporting a "bulge" at the site. CONCLUSION: Performing a bridged TAR repair with synthetic mesh in patients with complex hernias is associated with high rates of patient-reported bulge perception. Despite this, there was a significant improvement in quality-of-life metrics. When counseling these patients during preoperative evaluation, the results of our study should be shared in candor to aid in informed decision-making.