Less Is More: Standardization and Description of Partial Transversus Abdominis Release (pTAR) for W2–W3 Midline Incisional Hernia Repair

Background: Posterior component separation with transversus abdominis release (TAR) enables tension-free reconstruction of large midline incisional hernias but, when performed as a complete bilateral release, may expose selected patients to extensive lateral dissection and related morbidity. In daily practice, many surgeons already limit the release to the segment that is strictly required (“tailored”, “limited” or “modified” TAR), but this conservative use of TAR has never been explicitly defined, illustrated or reported in a reproducible way. We define this approach as partial transversus abdominis release (pTAR) and describe it in a standardized, stepwise fashion, reporting the preliminary outcomes of an initial single-surgeon series. Methods: We retrospectively reviewed all patients who underwent open midline incisional hernia repair with retromuscular synthetic mesh and pTAR performed by a single surgeon at a single center between January 2024 and January 2025. Complex hernias were defined a priori. Continuous variables are reported as mean ± standard deviation. The report is a technical note and preliminary case series. Results: Ten patients with complex W2–W3 midline incisional hernias were included. pTAR was performed in the subxiphoid segment in eight cases and in the periumbilical/middle segment in two cases. No major intraoperative complications occurred. Two patients developed a postoperative seroma, both classified as surgical site occurrences (SSO) not requiring intervention. One recurrence and one readmission were recorded; no reoperation or death occurred. Conclusions: pTAR is presented as a reproducible, standardized variant of posterior component separation rather than as a novel operation or as proof of superiority over complete TAR. Since this is a small, retrospective, single-surgeon, single-center series with a follow-up shorter than 12 months, the data demonstrate feasibility only; the hypothesized tissue-sparing advantage must be tested in prospective, registered, comparative studies.