Stepwise transversus abdominis muscle release for complex bi
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Management of subcostal incisional hernias is particularly complicated due to their proximity to the costochondral limits in addition to the lack of aponeurosis on the lateral side of the abdomen. Posterior component separation through the same previous incision is a safe and reproducible technique for these complex cases.

Doctors presented a multicenter and prospective cohort of patients diagnosed with bilateral subcostal incisional hernias on either clinical examination or imaging-based CT. The aim of this investigation was to assess the outcomes of abdominal wall reconstruction for subcostal incisional hernias through a new approach.

The outcomes reported were short- and long-term complications, including recurrence, pain, and bulging. Quality of life was assessed with the European Registry for Abdominal Wall Hernias Quality of Life score. A total of 46 patients were identified. All patients underwent posterior component separation.

--Surgical site occurrences occurred in 10 patients, with only 7 patients requiring procedural intervention.

--During a mean follow-up of 18 months, 1 case of clinical recurrence was registered. Also, there were 8 patients with asymptomatic but visible bulging.

--The European Registry for Abdominal Wall Hernias Quality of Life score showed a statistically significant decrease in the 3 domains (pain, restriction, and cosmetic) of the postoperative scores compared with the preoperative score.

In particular, the posterior component separation technique for the repair of subcostal incisional hernias through the same incision is a safe procedure that avoids injury to the linea alba. It is associated with acceptable morbidity, low recurrence rate, and improvement in patients’ reported outcomes.

Surgery
Source: https://doi.org/10.1016/j.surg.2021.04.007
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