Peritoneal flap repair for large (>8 cm width) recurrent incisional ventral hernia

The recurrence of large (>8 cm width) incisional hernias remains a challenging problem in surgical practice. We present a case report of a large recurrent incisional hernia following multiple prior procedures. The patient underwent a tension-free hernia repair using the hernia sac as a peritoneal flap. The surgical approach involved careful dissection and mobilisation of the hernia sac, which was then used to create peritoneal flaps on the anterior and posterior aspects of the mesh. This technique obviated the need for traditional component separation procedures, thereby preserving the integrity of the abdominal musculature. An intraoperative video is included to elucidate the procedural steps, demonstrating the meticulous handling of anatomical layers of the abdominal wall during peritoneal flap repair. This case highlights the efficacy of peritoneal flap repair as a viable alternative for managing large ventral hernias.