Preoperative CT parameters can help determine the need for transversus abdominis release (TAR) during laparoscopic repair of midline hernias.

• TAR was necessary in 57% of patients, correlating with hernia width >5 cm and rectus-to-defect ratio (RDR) <2.35.
• Patients needing TAR had hernias averaging 6 cm compared to 4 cm in those who didn’t (p<0.0001).

This assessment can optimize surgical planning and improve patient counseling.

• Diagnostic accuracy for an RDR cutoff of 2.35 was superior, aiding in better decision-making for surgeons.