Robotic Transversus Abdominis Release for Parastomal Hernia and Hypogastric Incisional Hernia - A Video Vignette

The technique of separation of the posterior components for the release of the transversus abdominis muscle (TAR) is a new technique 1, 2. The advantages include preservation of the neurovascular bundles, significant myofascial medialization and creation of a well‐vascularized plane for sublay mesh placement. Recently, the safety as well as long‐term clinical efficacy of the TAR technique has also been reported 3-5. We present the case of a patient (Video S1) with a parastomal hernia and also a hypogastric incisional hernia. He had had an anterior resection and subsequent terminal colostomy. Bilateral TAR was the only realistic way to rebuild the abdominal wall without tension. The usual indication for TAR is large mid‐line defects (usually ˃ 10 cm) where a traditional Rives–Stoppa repair fails to provide re‐approximation of the posterior layers and linea alba reconstruction nor create space for sufficient mesh overlap. The TAR procedure is a versatile technique that has been shown to work in challenging hernia locations such as subcostal, subxiphoid, flank, parastomal and suprapubic 3. Minimally invasive TAR is feasible and guarantees rapid postoperative recovery.