Salih TOSUN
Annals of Clinical and Analytical Medicine - 2026;17(4):398-402
Aim: This study aims to evaluate the effectiveness and advantages of performing posterior component separation (PCS) with or without transversus abdominis release (TAR) in abdominal wall reconstruction for large incisional hernias. Methods: A total of 444 patients underwent elective incisional hernia repair at our center. Ninety patients with large midline hernias (>5 cm) were treated using a PCS technique. Of these, 71 patients with defects <10 cm underwent PCS without TAR (Group 1), and 19 patients with defects >=10 cm underwent PCS with TAR (Group 2). Perioperative outcomes, postoperative pain (visual analog scale, VAS), seroma formation, and hernia recurrence were recorded and compared between groups with at least 1 year of follow-up. Results: PCS without TAR (Group 1) was associated with a shorter operative time, a less complex procedure, fewer seromas, and a shorter learning curve compared to PCS with TAR (Group 2). Group 1 patients also reported lower postoperative pain scores, and their abdominal wall defects were successfully reconstructed without deformity. Patients in Group 2 had larger hernia defects (>=10 cm) and underwent the more extensive TAR procedure. Conclusion: Midline closure with PCS is a well-established technique, but the optimal use of TAR in addition to PCS for large hernias is not clearly defined in the literature. Our findings suggest that PCS without TAR can be safely and effectively performed for large incisional hernias under 10 cm, with TAR reserved for larger or more complex cases.
