Posterior component separation with transversus abdominis release successfully addresses recurrent ventral hernias following anterior component separation

Purpose: Anterior component separation (ACS) with external oblique release for ventral hernia repair has a recurrence rate up to 32 %. Hernia recurrence after prior ACS represents a complex surgical challenge. In this context, we report our experience utilizing posterior component separation with transversus abdominis muscle release (PCS/TAR) and retromuscular mesh reinforcement.

Methods: Patients with a history of recurrent hernia following ACS repaired with PCS/TAR were retrospectively identified from prospective databases collected at two large academic institutions. Patient demographics, hernia characteristics (using CT scan) and outcomes were evaluated.

Results: Twenty-nine patients with a history of ACS developed 22 (76 %) midline, 3 (10 %) lateral and 4 (14 %) concomitant recurrences. Contamination was present in 11 (38 %) of cases. All were repaired utilizing a PCS/TAR with retromuscular mesh placement (83 % synthetic, 17 % biologic) and fascial closure. Wound morbidity consisted of 13 (45 %) surgical site occurrences including 8 (28 %) surgical site infections. Five (17 %) patients required 90-day readmission, and two (7 %) were related to wound morbidity. One organ space infection with frank spillage of stool resulted in the only instance of mesh excision. This case also represents the only instance of recurrence (3 %) with a mean follow-up of 11 (range 3–36) months.

Conclusion: Patients with a history of an ACS who develop a recurrence represent a challenging clinical scenario with limited options for surgical repair. A PCS/TAR hernia repair achieves acceptable outcomes and may in fact be the best approach available.