Abstract：
BACKGROUND: Abdominal surgery following transversus abdominis release (TAR) procedure commonly involves incisions through the previously implanted mesh, potentially creating vulnerabilities for hernia recurrence. Despite the popularity of the TAR procedure, current literature regarding post-AWR surgeries is limited. This study aims to reveal the incidence and outcomes of post-TAR non-hernia-related abdominal surgeries of any kind.
METHODS: Adult patients who underwent non-hernia-related abdominal surgery following ventral hernia repair with concurrent TAR procedure and permanent synthetic mesh in the Cleveland Clinic Center for Abdominal Core Health between January 2014 and January 2022 were queried from a prospectively collected database in the Abdominal Core Health Quality Collaborative. We evaluated 30-day wound morbidity, perioperative complications, and long-term hernia recurrence.
RESULTS: A total of 1137 patients who underwent TAR procedure were identified, with 53 patients (4.7%) undergoing subsequent non-hernia-related abdominal surgery post-TAR. Small bowel obstruction was the primary indication for reoperation (22.6%), and bowel resection was the most frequent procedure (24.5%). 49.1% of the patients required urgent or emergent surgery, with the majority (70%) having open procedures. Fascia closure was achieved by absorbable sutures in 50.9%, and of the open cases, fascia closure was achieved by running sutures technique in 35.8%. 20.8% experienced SSO, the SSOPI rate was 11.3%, and 26.4% required more than a single reoperation. A total of 88.7% were available for extended follow-up, spanning 17-30 months, resulting in a 36.1% recurrent hernia diagnosis rate.
CONCLUSIONS: Abdominal surgery following TAR surgery is associated with significant comorbidities and significantly impacts hernia recurrence rates. Our study findings underscore the significance of making all efforts to minimize reoperations after TAR procedure and offers suggestions on managing the abdominal wall of these complex cases.
METHODS: Adult patients who underwent non-hernia-related abdominal surgery following ventral hernia repair with concurrent TAR procedure and permanent synthetic mesh in the Cleveland Clinic Center for Abdominal Core Health between January 2014 and January 2022 were queried from a prospectively collected database in the Abdominal Core Health Quality Collaborative. We evaluated 30-day wound morbidity, perioperative complications, and long-term hernia recurrence.
RESULTS: A total of 1137 patients who underwent TAR procedure were identified, with 53 patients (4.7%) undergoing subsequent non-hernia-related abdominal surgery post-TAR. Small bowel obstruction was the primary indication for reoperation (22.6%), and bowel resection was the most frequent procedure (24.5%). 49.1% of the patients required urgent or emergent surgery, with the majority (70%) having open procedures. Fascia closure was achieved by absorbable sutures in 50.9%, and of the open cases, fascia closure was achieved by running sutures technique in 35.8%. 20.8% experienced SSO, the SSOPI rate was 11.3%, and 26.4% required more than a single reoperation. A total of 88.7% were available for extended follow-up, spanning 17-30 months, resulting in a 36.1% recurrent hernia diagnosis rate.
CONCLUSIONS: Abdominal surgery following TAR surgery is associated with significant comorbidities and significantly impacts hernia recurrence rates. Our study findings underscore the significance of making all efforts to minimize reoperations after TAR procedure and offers suggestions on managing the abdominal wall of these complex cases.
摘要：
背景：腹横肌释放（TAR）手术后的腹部手术通常涉及通过先前植入的网状物的切口，可能会造成疝气复发的漏洞。尽管TAR程序很受欢迎，关于AWR后手术的现有文献有限。这项研究旨在揭示TAR术后任何类型的非疝相关腹部手术的发生率和结果。
方法：2014年1月至2022年1月，在克利夫兰临床中心腹部核心健康中心进行腹侧疝修补术并同时进行TAR手术和永久性合成网片后接受非疝相关腹部手术的成年患者从“腹部核心健康质量协作”中前瞻性收集的数据库中进行查询。我们评估了30天的伤口发病率，围手术期并发症,和长期疝气复发。
结果：共确认了1137例接受TAR手术的患者，53例患者（4.7%）在TAR后接受后续的非疝相关腹部手术。小肠梗阻是再次手术的主要指征(22.6%),肠切除术是最常见的手术(24.5%)。49.1％的患者需要紧急或紧急手术，大多数人(70%)有开放的程序。50.9%的人通过可吸收缝线实现筋膜闭合，在公开案件中，通过缝合技术实现筋膜闭合的比例为35.8%。有20.8%的SSO经验，SSOPI率为11.3%，26.4%需要一次以上的重新手术。共有88.7%可用于延长随访,跨越17-30个月,导致36.1%的复发性疝诊断率。
结论：TAR手术后的腹部手术与显著的合并症相关，并显著影响疝复发率。我们的研究结果强调了尽一切努力减少TAR手术后再次手术的重要性，并为管理这些复杂病例的腹壁提供了建议。
方法：2014年1月至2022年1月，在克利夫兰临床中心腹部核心健康中心进行腹侧疝修补术并同时进行TAR手术和永久性合成网片后接受非疝相关腹部手术的成年患者从“腹部核心健康质量协作”中前瞻性收集的数据库中进行查询。我们评估了30天的伤口发病率，围手术期并发症,和长期疝气复发。
结果：共确认了1137例接受TAR手术的患者，53例患者（4.7%）在TAR后接受后续的非疝相关腹部手术。小肠梗阻是再次手术的主要指征(22.6%),肠切除术是最常见的手术(24.5%)。49.1％的患者需要紧急或紧急手术，大多数人(70%)有开放的程序。50.9%的人通过可吸收缝线实现筋膜闭合，在公开案件中，通过缝合技术实现筋膜闭合的比例为35.8%。有20.8%的SSO经验，SSOPI率为11.3%，26.4%需要一次以上的重新手术。共有88.7%可用于延长随访,跨越17-30个月,导致36.1%的复发性疝诊断率。
结论：TAR手术后的腹部手术与显著的合并症相关，并显著影响疝复发率。我们的研究结果强调了尽一切努力减少TAR手术后再次手术的重要性，并为管理这些复杂病例的腹壁提供了建议。
