Posterior Rectus Sheath Release: A More Anatomical Posterior Components Separation Technique

Miguel Angel Garcia Urena, MD, PhD, FACS; Javier Lopez-Monclus, MD, PhD, FACS; Carlos San Miguel, MD, PhD; Daniel A. Melero, MD; Luis Alberto Blazquez Hernando, MD; Alvaro Robin Valle de lersundi, MD, PhD; Enrique E. Gonzalez, MD, PhD; Asunci&oacutn Aguilera Velardo, MD

Product Details
Product ID: ACS-5569
Year Produced: 2018
Length: 9 min.


BACKGROUND: Posterior components separation with transversus abdominis release (TAR) technique is increasingly being used for abdominal wall reconstruction. The main purpose of this video is to present a modification of the surgical technique originally described that facilitates the surgical procedure and avoid the cutting of transversus abdominis muscle fibers. METHODS: The anatomical basis for this surgical modification are explained in the video: the transversus abdominis muscle runs horizontally over the visceral sac that is partially covered with a preperitoneal fat. The distribution of this preperitoneal areaolar tissue allows a modification of the conventional TAR. We present this technique in a young obese patient with a history of 2 failed previous umbilical repairs. The patient was prepared for the operation with botulin toxin and pneumoperitoneum. After a Rives dissection, the posterior rectus sheat is cut laterally, medial to linea semilunaris, starting in the arcuate line. In the supraumbilical area, the incision comes obliquely to meet the medial border of the posterior rectus sheat, previously cut in the Rives procedure. Then, the retromuscular preperitoneal plane is dissected to extend a large synthetic mesh over an absorbable mesh placed in the same retromuscular position. RESULTSThe patient was discharged uneventfully on the 6th postoperative day and the abdominal wall reconstruction achieved is shown. CONCLUSIONS: This novel modification allows a simpler dissection of the preperitoneal retromuscular space when performing the posterior components separation. It also enables to reinsert the lateral border of the posterior rectus sheath.