Laparoscopic Retromuscular Mesh Repair for the Management of Multiple Abdominal Wall Hernias

Summary

Laparoscopic retromuscular mesh repair (LRMR) technique offers a clear view of the abdominal wall anatomy and can be effectively combined with transversus abdominis release (TAR), allowing for tension-free repair and placement of large meshes extending beyond the semilunar lines, particularly in patients with multiple abdominal wall hernias.

Abstract

Laparoscopic retromuscular mesh repair (LRMR) is a minimally invasive and effective approach for treating multiple abdominal wall hernias. The goal of this protocol is to provide a reproducible surgical technique for the management of multiple abdominal wall hernias in the era of minimally invasive surgery. Here, we present a protocol to describe laparoscopic retromuscular mesh repair for the management of multiple abdominal wall hernias, enabling tension-free reconstruction and adequate mesh placement through a minimally invasive approach. The key procedural steps include: (1) creation of the retro-rectus space; (2) expansion of the retro-rectus space with exposure of the hernia defects; (3) crossing the midline to develop the contralateral retro-rectus space; (4) transversus abdominis release to further expand the retromuscular plane when necessary; (5) closure of the hernia defects with reconstruction of the posterior rectus sheath; and (6) retromuscular mesh placement with adequate overlap to ensure durable repair. This technique offers a practical and efficient alternative for the repair of multiple incisional hernias and facilitates tension-free anatomical reconstruction. In a representative case involving multiple abdominal wall hernias, the procedure was completed successfully without complications and was associated with favorable postoperative recovery, demonstrating the versatility and feasibility of the approach and highlighting its potential applicability in complex clinical scenarios.

Introduction

Large population-based studies have reported that primary ventral hernias occur in approximately 20% of adults, whereas incisional hernias—a postoperative subtype of ventral hernia—develop in up to 30% of midline abdominal incisions¹. LRMR has been applied in clinical practice for the treatment of ventral hernias^2,3. The key concept underlying this technique is to disrupt anatomical boundaries, connect the retromuscular planes, and create adequate space for mesh placement⁴. This approach preserves the principles of retromuscular reconstruction while a....

Protocol

The protocol follows the guidelines of the Human Research Ethics Committee of Nanchong Central Hospital of North Sichuan Medical College (University). Written informed consent was obtained from the patient for the procedure and the use of data.

1. Preoperative preparation (Figure 1, Figure 2)

1. Measure the size of the hernia defects by preoperative computed tomography (CT) in centimeters (cm). Also, record the quantity of hernia.
2. Hold a detailed discussion with the patient and their family to obtain informed consent.
3. Perform routine sk....

Results

In the representative case, preoperative CT and intraoperative assessment identified the following hernia defects: the midline epigastric incisional hernia (3.5 cm × 4.0 cm), midline hypogastric incisional hernia (2.5 cm × 3.0 cm), drain-site incisional hernia (1.5 cm × 1.5 cm), and right femoral hernia (internal ring diameter 2.0 cm) (Figure 1). The operative time was 320 min, with an estimated blood loss of 40 mL. No postoperative complications occurred. The patient resumed a fluid diet 6 .......

Discussion

This study demonstrates the technical aspects of LRMR for the management of multiple incisional hernias combined with femoral hernia. The primary contribution of this protocol lies in illustrating a standardized, reproducible approach to creating and extending the retromuscular space, enabling adequate mesh coverage under direct endoscopic visualization.

Several technical considerations proved essential for the successful performance of the procedure. First, TAR was employed to expand the retr.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Disposable surgical drainage tube	Shandong Branden Medical Devices Co., Ltd.	Round Tube Type, Fr14
High-definition laparoscopic system	Karl Storz	TC201
Knitted polypropylene pre-formed mesh	C.R. Bard	115311	10.8 cm × 16 cm
Laparoscopic forceps	Tonglu Youshi Medical Instrument Co., Ltd.	101.052	5 mm × 330 mm
Laparoscopic high-flow insufflator	Karl Storz	UI400
Laparoscopic needle holding pliers	Tonglu Youshi Medical Instrument Co., Ltd.	101.032A	5 mm × 330 mm
Laparoscopic scissors	Tonglu Youshi Medical Instrument Co., Ltd.	101.022	5 mm × 330 mm
Single-use trocar for laparoscopy	Surgaid	NGVM-100-1-5; NGVM-100-1-10
Surgical suture needles with thread	Ningbo Chenghe Microapparatus Factory		1-0, 80 cm
Surgical suture needles with thread	Shanghai Pudong Jinhuan Medical Products Co., Ltd.		2-0, 75 cm
Titanized meshes	Pfm Medical Gmbh	6000609, 6000674	20 cm × 15 cm