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Transversus Abdominis Release (TAR) Surgery

Posterior component separation technique that releases transversus abdominis muscle laterally to enable medial advancement of posterior rectus sheath, restore midline closure, and accommodate large retromuscular mesh in complex ventral hernia repair.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

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This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is Transversus Abdominis Release (TAR) Surgery?

Transversus abdominis release (TAR) is a posterior component separation technique that incises the posterior lamella of internal oblique aponeurosis just medial to the linea semilunaris, then divides transversus abdominis muscle laterally, providing 8–12 cm of medialization on each side.

TAR builds on the principles of Rives-Stoppa retromuscular repair but extends the dissection plane laterally beyond the linea semilunaris into the preperitoneal space, allowing mesh placement with very wide overlap (often 30×30 cm) without intraperitoneal exposure.

Compared with anterior component separation (Ramirez), TAR avoids large skin flaps and preserves epigastric vessels and intercostal innervation, leading to lower wound morbidity and similar or better hernia outcomes; it can be performed open, laparoscopically, or robotically (eTEP-TAR).

Symptoms

Complex ventral or incisional hernia with defect width over 8–10 cm not amenable to standard Rives-Stoppa or IPOM
Loss of domain (hernia sac volume more than 20% of abdominal cavity) requiring extensive medialization
Recurrent ventral hernia after multiple prior repairs
Parastomal, subxiphoid, or suprapubic hernias with limited mesh overlap zones
Symptoms: large midline bulge, intractable pain, recurrent skin breakdown, intermittent obstruction, dyspnea from impaired respiratory mechanics
Need for re-establishing midline anatomy and abdominal wall function in active patients

Risk Factors

Severe obesity with BMI over 50 — higher wound complications, often staged with weight loss first
Active smoking — strong predictor of wound complications and recurrence
Uncontrolled diabetes mellitus, malnutrition (albumin under 3.5 g/dL)
Recent abdominal sepsis or contaminated field — biologic or absorbable synthetic mesh consideration
Cardiopulmonary insufficiency — ICU support and individualized risk discussion
Connective tissue disease, prior multiple hernia repairs, prior pelvic radiation, large parastomal hernia

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Complex ventral hernia with defect over 10 cm or loss of domain — abdominal wall reconstruction center referral
  • Recurrent hernia after multiple prior repairs — specialist evaluation for posterior component separation
  • Acute incarceration or strangulation — emergency surgery (TAR rarely emergent)
  • Severe obesity with hernia — combined evaluation with bariatric team
  • Skin compromise over hernia (ulcer, infection) — wound care and timing of definitive repair

Treatment Methods

01
Preoperative optimization: weight reduction (BMI target under 40), smoking cessation 4–8 weeks, glycemic control HbA1c under 7%, nutritional optimization (albumin over 3.5), botulinum toxin to lateral abdominal wall 4–6 weeks before for very large hernias
02
Operative steps: midline incision, hernia sac excision and content reduction, retromuscular dissection, posterior lamella incision medial to linea semilunaris, transversus abdominis fiber division, lateral preperitoneal extension, posterior sheath closure (or peritoneum), mesh placement in retromuscular space, anterior fascial closure
03
Mesh selection: large lightweight macroporous polypropylene preferred for clean cases; biologic or absorbable synthetic in contaminated fields; size sufficient for ≥5 cm overlap of all defect borders
04
Postoperative care: monitored bed/ICU 24 hours, abdominal binder, multimodal analgesia (often TAP block or epidural), DVT prophylaxis, early ambulation, gradual diet advancement, restriction of heavy lifting for 8 weeks
05
Follow-up: clinic at 4 weeks, 3 months, 6 months, and annually with clinical exam and imaging if recurrence suspected; long-term registry participation; recurrence rate 5–12% at 5 years in expert centers

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.