Com­plex ab­do­mi­nal wall re­con­struc­tion

Several strategies are available for this purpose:

Pre-treatment of the lateral abdominal muscles with Botox: This involves paralysing the lateral abdominal muscles on both sides with Botox for a few weeks. This leads to reduced lateral tension on the abdominal wall and subsequently allows the hernia gap in the midline to be closed with significantly reduced tension. The abdominal wall is then usually reconstructed using an open procedure or robot-assisted procedure and insertion of a mesh behind the abdominal muscles.

Anterior component separation: This involves separating part of the lateral abdominal muscles at their attachment to the abdominal wall. This leads to reduced lateral tension on the abdominal wall and subsequently allows the hernia gap in the midline to be closed with significantly reduced tension. The abdominal wall is then usually reconstructed using an open procedure and inserting a mesh behind the abdominal muscles.

Transversus abdominis muscle release (TAR): In this technique, the posterior layer of the abdominal wall is separated along the posterior lateral abdominal muscle (transversus abdominis muscle) as far as the flank region on both sides. In addition to tension-free closure of the abdominal wall, this also enables the insertion of the largest possible mesh for large hernia gaps. The procedure can be performed open or minimally invasive with the surgical robot. TAR has largely replaced anterior component separation.