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Surgical Innovation |

Transversus Abdominis Release as an Alternative Component Separation Technique for Ventral Hernia Repair

Jeffrey A. Blatnik, MD1; David M. Krpata, MD2; Yuri W. Novitsky, MD2
[+] Author Affiliations
1Section of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
2Division of General Surgery, Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio
JAMA Surg. 2016;151(4):383-384. doi:10.1001/jamasurg.2015.3611.
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This review describes the innovative use of transversus abdominis release as an alternative component separation technique for ventral hernia repair and addresses limitations of traditional reconstructive options.

Section Editor: Justin B. Dimick, MD, MPH.

Submissions: Authors should contact Justin B. Dimick, MD, MPH, at jdimick@med.umich.edu if they wish to submit Surgical Innovation papers.

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Major Steps Involved in Transversus Abdominis Release

A, The retrorectus space is developed laterally until the perforating vessels are identified. The posterior rectus sheath is then incised (arrowheads). B, The transversus abdominis muscle (arrowheads) is divided to enter a retromuscular space. C, The transversus abdominis muscle (arrowheads) is elevated to enter an extraperitoneal plane that is continued laterally to the psoas, allowing for a large extraperitoneal plane. D, This enables additional midline advancement of the posterior rectus sheath. E, If necessary, this is performed on the opposite side and then the posterior rectus sheath is closed in the midline, isolating the visceral cavity. F, A large piece of mesh is placed in this plane to allow for reinforcement of the visceral sac. The final step (not shown) would be closure of the rectus abdominis and anterior rectus sheath in the midline, recreating the linea alba.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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