Understanding the perioperative morbidity associated with concomitant transversus abdominis release in retromuscular ventral hernia repair: a retrospective study.

INTRODUCTION: The need for ventral hernia repair is becoming increasingly prevalent, and there is a need for analysis of surgical techniques and their associated risks. We aimed to characterize the perioperative morbidity associated with robotic extended totally extraperitoneal (eTEP) hernia repair with concomitant transversus abdominis release (TAR), particularly in the context of more complex ventral hernias. METHODS: This retrospective study analyzed outcomes of patients undergoing eTEP hernia repair, stratified into two groups: those undergoing concomitant TAR and those without TAR at a single institution. Baseline demographics, hernia characteristics, intraoperative details, and postoperative complications were collected. RESULTS: Mean operative time was significantly longer in the TAR group (254 [187.25, 320.75] min vs. 198.5 [149.88, 247.12] min, p < 0.001), as were intraoperative length (5 [3.5, 6.5] cm vs. 4 [3, 5] cm, p < 0.001) and mesh dimensions (mesh length: 30 [25, 35] cm vs. 20 [12.5, 27.5] cm, p < 0.001; mesh width: 30 [25, 35] cm vs. 15 [7.5, 22.5] cm, p < 0.001). Adhesiolysis greater than 45 min (18.5% vs. 1.8%, p < 0.001) and drain use (50.8% vs. 30.9%, p < 0.001) were more frequent in the TAR group. While overall 30-day complications were similar (7.7% vs. 4.5%, p = 0.4), surgical site infections (SSI) were significantly higher in the TAR group (7.7% vs. 0.9%, p = 0.04). Postoperative pain was also reported more frequently in the TAR group (36.9% vs. 24.5%, p = 0.03). CONCLUSION: eTEP TAR may be associated with incremental perioperative morbidity, reflecting its use in more complex hernia repairs, but can be an excellent tool for appropriately selected patients with more complex hernias and associated comorbidities, as shown in our sample. Significant surgeon expertise and experience are recommended to perform this procedure, and recognition of this added morbidity is critical for appropriate patient selection and preoperative counseling, ensuring that TAR is reserved for cases in which its reconstructive benefits outweigh its risks.