Acute Kidney Injury After Large Ventral Hernia Repair Requiring Transversus Abdominis Release

Area of Science:

• Abdominal surgery
• Nephrology
• Surgical complications

Background:

• Acute kidney injury (AKI) is a significant complication following open ventral hernia repair.
• AKI increases healthcare costs, hospital stay, and mortality.
• The role of specific surgical techniques, like transversus abdominis release (TAR), in AKI development is unclear.

Purpose of the Study:

• To investigate the association between transversus abdominis release (TAR) and the incidence of postoperative acute kidney injury (AKI).
• To determine if the muscle injury from TAR contributes to AKI after ventral hernia repair.

Main Methods:

• Retrospective cohort study of 523 patients undergoing open retrorectus ventral hernia repair (2012-2019).
• Comparison of patients who had TAR (unilateral or bilateral) versus those who did not (non-TAR).
• AKI defined as >50% increase in creatinine from baseline; analyzed using univariate and multivariate models.

Main Results:

• 159 patients (30.4%) underwent TAR.
• TAR group had increased blood loss, fluid balance, and operative duration.
• AKI rate was 11% in the TAR group vs. 6% in the non-TAR group (P=0.0503).
• Multivariate analysis showed TAR significantly increased odds of AKI (OR 1.97, P=0.0521).

Conclusions:

• Transversus abdominis release (TAR) in retrorectus ventral hernia repair is associated with a nearly 2-fold increased risk of postoperative AKI.
• Patients undergoing TAR require optimized perioperative care, including fluid management and monitoring.
• Further research may explore strategies to mitigate AKI risk in these patients.