This technique uses release of the transversus abdominis muscle to increase the mobility of the abdominal wall compartments, facilitate closure of the defect and create a large retromuscular space for mesh placement.
The aim is not simply to close a hernia: it is to rebuild a wall that can return to the midline without excessive tension.
Indications
TAR may be considered in the presence of:
- Large incisional hernias
- Complex abdominal wall defects
- Recurrences after previous surgery
- Some complex lateral defects
small skin incisions
How the procedure is performed
- ICreating the retromuscular plane
A space is developed behind the rectus abdominis muscles, as in retromuscular reconstructions.
Developing the retromuscular plane. - IITransversus muscle release
The transversus muscle is released in a controlled way to increase the mobility of the lateral wall. This allows the tissues to be brought towards the midline and makes midline reconstruction easier.
- IIIReconstruction and mesh
The wall is reconstructed and a large mesh is placed in a deep plane, generally retromuscular/extraperitoneal.
Wall reconstruction. Retromuscular mesh. Layers from top to bottom: skin, subcutaneous tissue, anterior fascia, rectus muscle, retromuscular mesh (blue), posterior fascia, peritoneum, bowel loops.
Laparoscopy or robotics
Because of its complexity, TAR is performed mainly with a robotic approach:
The robotic platform makes some phases of deep dissection, suturing and extensive reconstruction easier, especially in the most complex cases.
Learn moreRobotic abdominal wall surgeryTiming and hospital stay
- About 4h
Duration of surgery
- 2–3 days
Hospital stay
Duration and hospital stay depend greatly on the complexity of the defect. Compared with techniques used for smaller defects, TAR is generally a more involved procedure and recovery is tailored to the clinical case.
Frequently asked questions
Is TAR also used for small hernias?
Generally not. It is a technique reserved mainly for large or complex defects.
Is the mesh intraperitoneal?
No, in TAR reconstructions the mesh is generally placed in a deep extraperitoneal/retromuscular plane.
Can TAR be performed robotically?
Yes. The robotic variant is commonly referred to as r-TAR.
Is TAR always needed for recurrent incisional hernias?
No. It depends on size, location, previous surgery and whether the midline can be reconstructed without tension.
Complex incisional hernias require a reconstructive strategy
TAR is one of the techniques that can be used when the wall cannot be reconstructed properly without increasing tissue mobility. The choice depends on defect size, recurrences, tissue quality and abdominal wall anatomy.