Comparative Study of Posterior Component Separation Transverse Abdominis Release and Onlay Mesh Repair in Large Incisional Hernias

Introduction: Large incisional hernias (>10 cm) pose significant surgical challenges, with high rates of complications and recurrence. Posterior Component Separation with Transversus Abdominis Release (PCS-TAR) has emerged as an advanced technique aimed at improving outcomes compared to conventional onlay mesh repair. Aim of the study was to compare PCS-TAR with conventional onlay mesh repair in the management of large incisional hernias.

Material and Methods: This prospective comparative study included 40 patients randomized into two groups: PCS-TAR (n=20) and onlay mesh repair (n=20). Outcomes assessed included operative duration, postoperative pain (VAS), complications (wound discharge, gaping, flap necrosis, debridement), hospital stay, and recurrence over 12 months. Statistical analysis was performed using SPSS, with p<0.05 considered significant.

Results: Operative time was significantly longer in the PCS-TAR group (p<0.001). PCS-TAR showed significantly lower postoperative pain (p<0.001), reduced hospital stay (p=0.025), and lower rates of flap necrosis and debridement (p=0.02). Wound discharge and gaping were comparable between groups. Recurrence was lower in PCS-TAR (5%) compared to onlay repair (10%), though not statistically significant.

Conclusion: PCS-TAR is a superior technique for large incisional hernias, offering better postoperative outcomes and fewer complications despite longer operative time.