What Is a Complex Ventral Hernia?

A complex ventral hernia is a more challenging type of abdominal wall hernia. These hernias are typically:

• Larger in size
• Recurrent (the hernia has come back after previous repair)
• Located in difficult areas such as off to the side, near the belly button, or near bones
• Associated with previous surgeries

Complex hernias often cannot be repaired with standard techniques and require advanced surgical approaches to achieve a durable, lasting repair.

What Is TAR (Transversus Abdominis Release)?

TAR stands for Transversus Abdominis Release. It is an advanced surgical technique used to repair very large or complex ventral hernias. TAR is also called posterior component separation because it involves releasing one of the deeper layers of your abdominal wall muscles (the transversus abdominis muscle) to allow the surgeon to bring the muscles back together in the midline.

Think of it like letting out a seam in clothing to make it fit better—the TAR technique allows your surgeon to gain extra tissue to close large defects that otherwise could not be closed.

What Is Robotic TAR?

Robotic TAR (rTAR) uses a robotic surgical system to perform this complex repair through small incisions rather than one large open incision.] During the procedure:

1. You’ll receive general anesthesia, so you’ll be asleep
2. The surgeon makes 3-4 small incisions in your abdomen
3. Using robotic instruments controlled from a console, the surgeon works in the space behind your abdominal muscles
4. The transversus abdominis muscle is carefully released on both sides to create more room
5. This allows the surgeon to bring your abdominal muscles back together in the midline and close the hernia defect
6. A large piece of surgical mesh is placed behind the muscles to reinforce the repair
7. The mesh is sewn in place with sutures

The surgeon is in complete control at all times—the robot provides enhanced 3D visualization and precise instrument movements but does not operate on its own.

Why Would I Need TAR Instead of a Standard Repair?

Your surgeon may recommend TAR if you have:

• A very large hernia
• A hernia that has come back after previous repairs, especially if you’ve had prior mesh placed
• A hernia in a difficult location (off-midline, near ribs, or involving multiple areas)
• Loss of abdominal domain (when the hernia has been present so long that your abdominal contents no longer fit inside)
• A hernia that cannot be closed with simpler techniques

TAR is specifically designed for these challenging situations where standard repairs would likely fail.

What Are the Benefits of Robotic TAR?

Research comparing robotic TAR to open TAR (using one large incision) shows several important advantages:

Shorter Hospital Stay:

• Robotic TAR: Average 1-3 days in the hospital
• Open TAR: Average 6-9 days in the hospital

Fewer Complications:

• Overall complications: 9% with robotic vs. 25% with open
• Surgical site infections: 2.5% with robotic vs. 8% with open
• Systemic complications (heart, lung, blood clot problems): 6% with robotic vs. 27% with open

Less Blood Loss:

• Robotic TAR results in significantly less bleeding during surgery (about 50 mL vs. 140 mL)

Similar Long-Term Success:

• Both approaches have excellent recurrence rates, with studies showing 0-5% recurrence at 1-2 years

What Should I Expect for Recovery?

In the Hospital:

• Most patients stay 1-2 days after robotic TAR
• You can usually eat a regular diet within 24 hours
• Pain is typically well-controlled with medication
• You’ll be encouraged to walk soon after surgery

First Few Weeks:

• You may have some soreness, swelling, and bruising—this is normal
• Most patients can resume light daily activities within 1-2 weeks
• Avoid heavy lifting (typically anything over 10-20 pounds) for the first 4-6 weeks
• Your surgeon will give you specific activity restrictions based on your repair

Returning to Full Activity:

• Return to work varies depending on your job—desk work may be possible in 2-3 weeks, while physical labor may require 6-8 weeks or more
• Strenuous exercise and heavy lifting are typically restricted for 6-8 weeks
• Full healing of the abdominal wall takes several months