Laparoscopic transabdominal retromuscular repair with hernia sac-assisted mesh coverage for incisional ventral hernia: a prospective case series with preliminary outcomes

Repair of moderate-to-large-sized ventral incisional hernias often requires component separation to achieve tension-free posterior layer closure. Transversus abdominis muscle release (TAR), although effective, increases operative complexity and morbidity. We describe a tissue-preserving laparoscopic transabdominal retromuscular repair with hernia sac-assisted mesh coverage without TAR. Five patients with incisional ventral hernia underwent this procedure. The hernia sac was carefully dissected while maintaining continuity with the peritoneum and used to cover the retromuscular mesh. Primary fascial closure was achieved using barbed sutures, and a polypropylene mesh was placed in the retrorectus plane. There were no intraoperative complications. Seroma occurred in three patients and resolved with conservative management without aspiration. At a median follow-up of 10 months, no recurrence or chronic pain was observed. This technique may be a feasible tissue-preserving option to facilitate posterior layer closure without TAR in selected patients, with preliminary outcomes.