ArticleHernia : the journal of hernias and abdominal wall surgery2026
Favorable one-year outcomes despite residual fascial tension after ventral hernia repair with transversus abdominis release.
Article in Hernia : the journal of hernias and abdominal wall surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeFascial tension is thought to adversely impact herniorrhaphy, but the impact of residual tension on outcomes is uncharacterized beyond the immediate postoperative period. We previously reported fascial tension changes in a case series of patients who underwent posterior component separation with transversus abdominis release (PCS-TAR) and found no association between anterior fascia closure tension and early surgical outcomes. Here we consider patient outcomes at and beyond one postoperative year.
methodsIn this post-hoc analysis of a previously reported case series, surgical and patient-reported outcomes beyond one year were compared to the force (lbs) required to medialize anterior fascial elements before and after PCS-TAR. Patient demographics and surgical outcomes were captured in the Abdominal Core Health Quality Collaborative (ACHQC) registry, which was queried to identify surgical outcomes, including recurrence, wound morbidity, and patient-reported quality of life (QoL; hernia-specific and pain). Univariate regressions tested strength of association between fascial tension measures (baseline, closure, and intraoperative delta) and outcomes of interest.
resultsOf the 100 patients in the original case series, long-term clinical or patient-reported follow-up was available for 77. The long-term cohort had a median hernia width of 13 cm (IQR 10, 15), median baseline fascial tension of 11 lbs (IQR 6, 19) and median closure tension of 4 lbs (IQR 2, 8). Recurrence rate was 1.4% (n = 1) among those with clinical follow-up. No tension measures were associated with recurrence, wound morbidity, or patient-reported outcomes.
conclusionsIn this exploratory analysis of 77 abdominal wall reconstruction operations with PCS-TAR, a near absence of adverse outcomes were observed at one year among cases with a median residual midline closure tension of 4 lbs. Hernia-specific QoL and pain were not associated increased closure tension. The analyses are markedly limited by low event rates but tentatively suggest safety within the observed range of residual tension measurements. Larger cohorts featuring higher tension measurements are necessary to substantiate the findings and identify an upper limit of 'safe' residual tension.
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