University of Oulu

Maxime Dewulf and others, Open versus robotic-assisted laparoscopic posterior component separation in complex abdominal wall repair, BJS Open, Volume 6, Issue 3, June 2022, zrac057,

Open versus robotic-assisted laparoscopic posterior component separation in complex abdominal wall repair

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Author: Dewulf, Maxime1; Hiekkaranta, Juha M.2; Mäkäräinen, Elisa2;
Organizations: 1Maastricht UMC+, Maastricht, The Netherlands
2Oulu University Hospital, Oulu, Finland
3Maria Middelares Hospital, Gent, Belgium
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.4 MB)
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Language: English
Published: John Wiley & Sons, 2022
Publish Date: 2023-07-07


Background: Transversus abdominis release (TAR) is a surgical technique used in the treatment of complex ventral hernias. The aim of this study was to compare outcomes of open (oTAR) versus robotic-assisted (rTAR) posterior component separation by TAR.

Methods: Consecutive patients at two European hernia centres who underwent bilateral TAR were included. The primary endpoint was the duration of postoperative hospital stay.

Results: Data from 90 rTAR and 79 oTAR operations were evaluated. Patient demographics were similar between groups in terms of age, sex, BMI, and co-morbidities. There were more smokers, and hernias were larger in the oTAR group (width 8.7 cm versus 10.0 cm; P = 0.031, length 11.6 cm versus 14.1 cm; P = 0.005). Duration of postoperative hospital stay was significantly shorter in the rTAR group (3.4 days versus 6.9 days; P < 0.001). Short-term serious complications (Clavien–Dindo grade III and above) were more frequent (20.3 per cent versus 7.8 per cent; P = 0.018), and there were more surgical site infections (12.7 per cent versus 3.3 per cent; P = 0.010) in the oTAR group. During a median follow-up of 19 months in the rTAR group and 43 months in the oTAR group, reoperation (4.4 per cent versus 8.9 per cent; P = 0.245), and recurrence rates (5.6 per cent versus 5.1 per cent; P > 0.009) were similar.

Conclusion: Patients with ventral incisional hernias who undergo bilateral rTAR had significantly shorter postoperative hospital stays and fewer short-term complications compared with patients undergoing bilateral oTAR.

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Series: BJS open
ISSN: 2474-9842
ISSN-E: 2474-9842
ISSN-L: 2474-9842
Volume: 6
Issue: 3
Article number: zrac057
DOI: 10.1093/bjsopen/zrac057
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Copyright information: © The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact