Transversus abdominis muscle release for repair of complex incisional hernias in kidney transplant recipients

• Novel technique for incisional hernia repair in patients with a kidney allograft.
• Demonstrates that the TAR technique is safe and durable.
• Acceptable wound morbidity.
• No compromise in graft function.

BackgroundIncisional hernias in kidney transplant recipients (KTRs) can be complex because of adjacent bony structures, proximity of the allograft/transplant ureter, and context of immunosuppression. We hypothesized that our novel posterior component separation with transversus abdominis muscle release (TAR) and retromuscular mesh reinforcement offers a safe and durable repair.MethodsKTRs with incisional hernias repaired using the aforementioned technique were identified within our prospective database (2007 to 2013) and analyzed.ResultsEleven patients were identified (median age 49 years, body mass index 32). The median hernia size was 30 cm2 (range 88 to 1,040 cm2) and 8 of the 11 patients were recurrent. Intraoperative morbidity consisted of one transplant ureter injury repaired primarily over a stent. Postoperative morbidity consisted of 2 superficial surgical site infections that resolved and 1 readmission for a blood transfusion. There were no instances of mesh infection, explantation, graft loss, or graft dysfunction. With a median follow-up of 12 months (range 3 to 69), 1 (9%) lateral recurrence has been documented.ConclusionsFor complex incisional hernias in KTRs, TAR is associated with low perioperative morbidity and durable repair.