Title

Animation

1. Introduction

2. Incision and Entry into the Abdomen Along the Midline

3. Dissection Laterally to Remove Bowel from Defects from Known to Unknown

4. Running the Bowel

5. Measuring the Defect and Protecting the Bowel

6. Right Posterior Rectus Sheath Incision and Development of Posterior Rectus Space

7. Transversus Abdominis Release (TAR) on the Right

8. Closure of Lateral Defects on the Right

9. Left Posterior Rectus Sheath Incision and Development of Posterior Rectus Space

10. TAR on the Left

11. Further Cephalad Dissection Around Diaphragm

12. Closure of any Remaining Defects

13. Posterior Rectus Sheath Closure

14. Mesh Placement

15. Drain Placement

16. Skin Excision

17. Anterior Rectus Sheath Closure

a. Placement of Additional Drain

18. Closure

19. Post-op Remarks

This video demonstrates a case involving an open complex abdominal wall reconstruction with transversus abdominis release. The case involves an obese patient with a multiply recurrent incarcerated incisional hernia. The CT scan shows a complex defect involving the midline, right linea semilunaris, and inter-rectus hernia. The use of a retromuscular procedure with a posterior component separation will be highlighted and its advantages of allowing wide mesh overlap without creation of subcutaneous tissue flaps to repair defects with these challenging characteristics.

Watch this full-length, narrated surgical video of a complex abdominal wall reconstruction with transversus abdominis release (TAR) performed by Dr. Michael Rosen at the Cleveland Clinic.

Cleveland Clinic