Transversus abdominis release (TAR)

Steps of transversus abdominis release (TAR).
(Panel A) Following a midline incision and complete adhesiolysis, the posterior rectus sheath is incised 0.5 to 1 cm from the medial edge of the rectus muscle. The retrorectus plane is developed laterally to the semilunaris line. Neurovascular bundles are preserved.
(Panel B) The posterior rectus sheath is again incised 0.5 cm medial to the junction of the anterior/posterior rectus sheaths to expose the transversus abdominis muscle fibers, which are divided in a cephalad to caudad direction (the release).
(Panel C) The plane between the transversus abdominis muscle ventrally and the transversalis fascia/peritoneum dorsally is developed laterally toward the retroperitoneum/psoas muscle. The same procedure can be repeated on the contralateral side if necessary.
(Panel D) Posterior rectus sheaths are reapproximated in the midline. A mesh is typically placed behind the rectus muscles (sublay) and secured with full-thickness, transfascial sutures. The anterior rectus sheaths are then reapproximated at the midline to restore linea alba anterior/ventral to the mesh.