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Assessment of myofascial medialization following posterior component separation via transversus abdominis muscle release in a cadaveric model

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Abstract

Purpose

Posterior component separation (PCS) via the transversus abdominis release (TAR) procedure continues to gain popularity. However, neither the physiologic basis nor the extent of myofascial medialization after TAR is established. We aimed to assess both anterior and posterior rectus fascia (AF and PF) medialization following each step of the TAR procedure.

Methods

Ten fresh cadavers underwent PCS via TAR. Steps included midline laparotomy (MLL), retrorectus dissection (RRD), incision of the posterior rectus sheath (IPL), transversus abdominis muscle division (TAD), and retromuscular dissection (RMD). Medial advancement of AF and PF was measured following application of 2.5, 5.0 lb, and maximal tension to the fascial edge. Values are represented as mean advancement past midline in centimeters.

Results

MLL allowed advancement of 2.5, 3.7, and 4.9 cm. RRD provided advancement of 4.1, 5.9, and 7.6 cm for AF and 4.4, 6.2, and 7.5 cm for PF. IPL provided advancement of 4.2, 6.1, and 8.0 cm for AF and 4.6, 6.6, and 8.3 cm for PF. TAD provided advancement of 4.5, 6.6, and 8.6 cm for AF and 5.3, 7.5, and 9.5 cm for PF. RMD provided advancement of 5.5, 7.9, and 9.9 cm for AF and 6.9, 9.6, and 11.2 cm for PF. Overall, the complete TAR procedure provided AF advancement of 102% and PF advancement of 129%, over baseline.

Conclusions

The TAR procedure provides for substantial medial advancement of both anterior and posterior myofascial components of the abdominal wall. Retromuscular dissection deep to the divided transversus abdominis muscle appears to be the key step of the procedure, allowing for effective reconstruction of very wide (≈ 20 cm) defects.

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Funding

No external funding was used for this study.

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Authors and Affiliations

  1. Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA

    A. Majumder, H. J. Miller, L. M. del Campo, H. Soltanian & Y. W. Novitsky

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  1. A. Majumder
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  2. H. J. Miller
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  3. L. M. del Campo
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  4. H. Soltanian
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  5. Y. W. Novitsky
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Corresponding author

Correspondence to A. Majumder.

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Conflict of interest

AM, HJM, LMD, and HS declare no conflict of interest. YWN declares conflict of interest (consultant for C.R. Bard, Inc, Intuitive Surgical, and Cooper Surgical, Inc.) not directly related to the submitted work.

Ethical approval

Ethical approval was also exempt as this again was a non-living tissue study.

Human and animal rights

This study was IRB exempt as it was with non-living tissue.

Informed consent

No consent was needed as the cadavers had consented to tissue donation for their respective provides.

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Majumder, A., Miller, H.J., del Campo, L.M. et al. Assessment of myofascial medialization following posterior component separation via transversus abdominis muscle release in a cadaveric model. Hernia 22, 637–644 (2018). https://doi.org/10.1007/s10029-018-1771-7

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  • DOI: https://doi.org/10.1007/s10029-018-1771-7

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