Repair of Large Hernias - Chemical Component Separation with Botox and Relief of the Transversus Abdominis Muscle (TAR)

Hernias are defects or weak points in the abdominal wall, which leads to a bulging of the peritoneum and, as a result, of the intestines.The most common forms are inguinal hernia, femoral hernia, umbilical hernia and incisional hernia. They can be congenital, acquired, or appear after primary surgery.

Incisional hernias are a common late complication of abdominal surgery. The risks of developing incisional hernias depend on several factors. The occurrence of a hernia after open abdominal surgery is described in the literature as 10-20%. Large abdominal hernias are also more common in obese patients.

A hernia repair can only be done surgically. If parts of the intestine are displaced or trapped, an immediate medical consultation is strongly recommended.

In the case of large incisional hernias of the abdominal wall with a size of more than 10 cm, an open posterior component separation, the so-called Transversus abdominis muscle release (TAR), is recommended. This is a special procedure that is not offered by many specialists. Such massive hernias can hardly be handled with standard operations and the recurrence rate is very high. A complete recovery is possible with the new method.

In order to facilitate the closure of the abdominal wall and to increase the flexibility of the muscles, botox is introduced into the lateral muscles before surgery. The botulinum toxin is a neurotoxic poison, which causes a temporary relaxation of the muscles for 2-5 months. The maximum effect is reached 3 to 4 weeks after infiltration. This is followed by the open surgical repair of the incisional hernia by relieving the muscle transversus abdominis - TAR.

The advantage of this surgical technique is that a tension-free closure is possible through the introduction of a larger permanent plastic mesh. In the TAR method, the plastic mesh lies between the peritoneum (peritoneum), the straight abdominal muscle and the transverse abdominal muscle. The tendon strip in the middle of the abdominal wall (Linea Alba) can be reconstructed again through the extended lateral preparation of the region.

The average hospital stay is 3 to 5 days.

Physical rest or avoidance of lifting and carrying over 5kg should be observed for at least 5 weeks. During this time it is strongly recommended to wear an elastic bandage. The postoperative results of the combination of chemical component separation with Botox and a second retromuscular mesh implantation (Rive-Stoppa and / or TAR) are overall very promising.

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