[Large eventrations of the abdominal wall. A technique of aponeurotic plasty associated with a prosthesis]

Surgical repair of major incisional hernia of the abdominal wall is a technically challenging operation. It is not exceptional to be faced with major loss of parietal tissue requiring associated aponevrosis plasty and prosthesis implantation. We report a new technique involving transposition of the aponevrosis sheaths of the rectus abdominis creating a new muscular sheath. The prosthesis thus becomes extra-peritoneal and is inserted deep into the new muscular sheath thus protecting both the intestine and the skin. This technique can be used as an alternative when the size of the defect makes it impossible to bring the two borders of the rectus sheath together. Due to the transposition of the aponevroses, the sutures are placed laterally to the rectus abdominis so the plasty can also be applied when prosthesis implantation is contraindicated.