1 of 21

Retrorectus, Anterior Components, and Posterior Components Release Exposures

Matthew Bradley, MD, FACS

CAPT, MC, USN�Norman M. Rich Professor and Chair of Surgery

Uniformed Services University of the Health Sciences &

The Walter Reed National Military Medical Center

2 of 21

3 of 21

4 of 21

5 of 21

6 of 21

MESH PLACEMENT

7 of 21

RETRORECTUS EXPOSURE

8 of 21

RETRORECTUS EXPOSURE

9 of 21

10 of 21

ANTERIOR COMPONENTS RELEASE

11 of 21

ANTERIOR COMPONENTS RELEASE

12 of 21

Transversus Abdominus Release (TAR)

13 of 21

Photo’s courtesy of Dr. Fischer

14 of 21

Transversus Abdominus Release (TAR)

15 of 21

Photo’s courtesy of Dr. Fischer

16 of 21

17 of 21

18 of 21

Mesh Types and when/Where to use them

Two Broad Categories

Biological Synthetic

19 of 21

Synthetic mesh

  • What kind to you want to reinforce the hernia repair and reduce recurrence/complications:
    • Large Pore size (> 75 microns)
      • Allows for ingrowth of macrophages, fibroblasts, blood vessels, collagen
    • Lightweight (<33 gm/cm2)
      • Less foreign body rxn less inflammation better ingrowth less contraction, pain, and discomfort

​

​

​

20 of 21

Options for mesh fixation

  • Transfascial sutures
  • Quilting
  • Tacks
  • Glue
  • No fixation

21 of 21

Summary

  • Develop the retrorectus space by incising the rectus sheath
  • Preserve the neurovascular bundle
  • Incision lateral to the semilunar line to begin the Anterior Release
  • Incise medial to the neurovascular bundle to begin the TAR plane
  • Start the TAR plane at the superior aspect of the dissection