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Published on: September 7, 2022
Posterior components separation during retromuscular hernia repair
A M Carbonell1, W S Cobb, S M Chen
1Division of Minimal Access and Bariatric Surgery, Department of Academic Surgery, Greenville Hospital System University Medical Center, Greenville, SC 29605, USA. acarbonell@ghs.org
Background:
Retromuscular ventral hernia repair with mesh is a durable technique. In this paper, we describe a novel technique which allows for significant mesh overlap via the retromuscular space in cases of massive ventral hernia.
Methods:
The retromuscular space is developed laterally, to the edge of the rectus sheath. The posterior rectus sheath is incised, dividing the posterior aponeurosis of the internal oblique. The dissection is carried out laterally between the internal oblique and the transversus abdominis muscle, creating space for a large mesh underlay.
Results:
We have performed this technique successfully in 20 patients with a mean defect area of 223 cm(2) and a mean mesh area of 698 cm(2). Three patients developed wound complications and none complained of long-term pain or abdominal wall deformity. There has been one recurrence due to technical error after a mean 12-month follow-up.
Conclusion:
This technique of dissection between the internal oblique and transversus abdominis muscles allows for the closure of large hernia defects. The mechanism is two-fold: (1) mobility for closure of the posterior rectus sheath, dorsal to the prosthetic; and (2) increased mobility of the rectus, internal, and external obliques, allowing reconstruction of the linea alba.
Insights
This novel retromuscular ventral hernia repair technique creates significant mesh overlap for massive hernias. It allows for robust abdominal wall reconstruction, reducing recurrence risk.
Area of Science:
- Abdominal wall reconstruction
- Surgical innovation
- Hernia repair techniques
Background:
- Retromuscular ventral hernia repair using mesh is a proven durable method.
- Massive ventral hernias present challenges for adequate mesh coverage.
- A novel technique is presented to achieve substantial mesh overlap in the retromuscular space.
Purpose of the Study:
- To describe a new surgical technique for retromuscular ventral hernia repair.
- To facilitate significant mesh overlap in the retromuscular space for large hernias.
- To address the challenges of repairing massive ventral hernias.
Main Methods:
- Developing the retromuscular space laterally to the rectus sheath edge.
- Incising the posterior rectus sheath and posterior aponeurosis of the internal oblique.
- Dissecting between the internal oblique and transversus abdominis muscles to create space for mesh underlay.
Main Results:
- The technique was successfully applied in 20 patients with large defects (mean 223 cm²).
- A large mesh area (mean 698 cm²) was utilized, ensuring adequate coverage.
- Low complication rates were observed, with no long-term pain or deformity reported; one recurrence occurred.
Conclusions:
- Dissection between internal oblique and transversus abdominis muscles enables closure of large defects.
- The technique provides mobility for posterior sheath closure and rectus muscle reconstruction.
- This approach allows for effective abdominal wall reconstruction in massive ventral hernias.
