Use of Transversalis Fascia and Its Release in Abdominal Wall Reconstruction

Otto N. Thielen, BS; Sean R. Maloney, MD; Paul D. Colavita, MD; Vedra A. Augenstein, MD, FACS; Brant T. Heniford, MD, FACS

Product Details
Product ID: ACS-5813
Year Produced: 2019
Length: 12 min.


The popularity of component separation in AWR has led to a greater understanding of the abdominal wall anatomy. The transversus abdominis release (TAR) along with the development of the preperitoneal plane facilitates closure of the abdomen but also the placement of a large mesh away from the viscera. This video demonstrates the TAR but also the use of transversalis fascia to facilitate the preperitoneal dissection. A 69-year-old woman with multiple comorbidities who presented with a ventral incisional hernia following a complex abdominal surgery with subsequent complications. A TAR was performed for a 288cm2 defect, and a 42x48cm mid-weight polypropylene mesh was positioned in the preperitoneal space. In a brief second case, a totally extra-peritoneal dissection performed for a large hernia defect, the transversalis fascia was used to assist the preperitoneal dissection in order "thicken" the peritoneum so as to not enter the peritoneal cavity proper. One of the important advantages of a TAR is that it provides a large surface area to place a large mesh in big defects. Taking advantage of the thin transversalis fascia to facilitate the extra-peritoneal dissection is a little-known surgical method to complete this challenging dissection.