26vzmnrw076 10.3205/26vzmnrw076 urn:nbn:de:0183-26vzmnrw0769 Meeting Abstract Stanko Stanko B. B

General Hospital, General Surgery, Prijedor, Bosnia and Herzegovina

author Mitrić Mitrić M. M

General Hospital, General Surgery, Prijedor, Bosnia and Herzegovina

author German Medical Science GMS Publishing House

Düsseldorf

610 20260618 engl This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). M0644 076 Niederrheinisch-Westfälische Gesellschaft für Chirurgie Gesellschaft für Gastroenterologie in Nordrhein-Westfalen e.V. 192. Jahrestagung der Niederrheinisch-Westfälischen Gesellschaft für Chirurgie, 34. Jahrestagung der Gesellschaft für Gastroenterologie Viszeralmedizin NRW 2026 Chirurgie Dortmund 20260618 20260619 076 TextBackground and objective: Transversus abdominis muscle release (TAR) is a new myofascial release technique that involves the creation of a retro rectal place and mesh placement. It is a modification of the posterior component separation technique (CST) and enables the primary closure of the most challenging abdominal wall reconstructions. We present a case of giant ventral incisional hernia, where a favorable outcome was achieved with Transversus abdominis muscle release technique (TAR), in a contaminated environment with almost no perioperative complications and no recurrence after 5 years, with the placement of inexpensive non-absorbable ‘Paha’ mesh.Method: A 70-year-old man with a history of two previous abdominal operations presented with a giant ventral incisional hernia for elective repair. The hernia developed after an emergency laparotomy for adhesional ileus, complicated by wound dehiscence, evisceration, reoperation, and surgical site infection. On examination, a massive ventral hernia measuring approximately 80 × 40 cm was present. CT imaging showed a rectus defect of about 20 × 20 cm, with bowel adherent to the skin. During surgery, extensive adhesiolysis was required, and approximately 15 cm of small intestine was resected, followed by T–T ileo-ileal anastomosis, creating a contaminated operative field. Posterior component separation with transversus abdominis release was performed. The posterior layer was reconstructed with absorbable sutures, and two non-absorbable polypropylene meshes (30 × 30 cm) were placed in the retromuscular sublay position. As the anterior sheath could not be approximated, panniculectomy and scar excision were performed before skin closure.Result: The postoperative course was uneventful. The patient was mobilized early and discharged on postoperative day 11. A minor wound seroma resolved spontaneously. No surgical site infection, skin necrosis, major complications, or recurrence were observed during follow-up.Summary: Our case shows that even the most challenging abdominal wall hernias can be reconstructed with TAR. It is a safe, effective, and reliable technique with low perioperative morbidity as well as reduced risk of skin necrosis and surgical site infection. Recurrence rates, however, are yet to be analyzed. Additionally, the successful use of synthetic mesh reinforcement (in the most suitable retro muscular sublay plane), even in a contaminated environment, is possible, leading to a favorable outcome. 0 0 0 0