Transversus Abdominis Release in the Treatment of Complex Ventral Hernia: A Prospective Observational Study

Abstract

Background: Complex ventral hernias carry high recurrence and wound-morbidity rates after conventional repair. Transversus abdominis release (TAR), a posterior component separation, permits tension-free midline closure with reduced wound complications, but data from resource-limited settings remain scarce.

Objective: To evaluate the surgical outcomes of TAR in complex ventral hernia, with emphasis on primary fascial closure, recurrence, postoperative complications, recovery, and quality of life.

Methods: In this prospective observational study, 25 adults with complex ventral hernia underwent open TAR at a tertiary-care centre between 2025 and March 2026. Hernias were graded by the European Hernia Society system. Peritoneal (hernia-sac) flap augmentation (“TAR-plus”) was used when the posterior sheath could not be reapproximated. Outcomes were assessed at 1, 3, 6, and 12 months; quality of life was measured with the Carolinas Comfort Scale.

Results: Mean age was 46.4 years; 52% were female and 64% had W3 (>10 cm) defects. Bilateral TAR was performed in 68%. Primary fascial closure was achieved in all 25 patients. No complication occurred in 68%; superficial surgical-site infection (16%), seroma (8%), and mesh infection (4%) were the principal events, and the single mesh infection was salvaged without explantation. Mean hospital stay was 15.2 days. The mean Carolinas Comfort Scale score was 0.46, with marked functional and cosmetic improvement and no clinically detectable recurrence during follow-up.

Conclusion: TAR, with selective peritoneal-flap augmentation, offers durable, tension-free repair of complex ventral hernia with low morbidity and excellent recovery, and is well suited to resource-limited settings.