Open incisional hernia repair with retromuscular mesh augmentation

The present skin scar is excised completely

Dissect down to the fascia and fully expose the entire fascial scar.

When opening the abdominal cavity, the fascial scar is transected completely.

It is not enough to repair the fascial defect because frequently there are small multiple incisional hernia orifices.

Local adhesiolysis of abdominal organs in the hernia sac allows better overview and helps avoid iatrogenic bowel lesions when dissecting the tissue for the mesh bed.

Follow this by covering the abdominal cavity with a warm wet laparotomy pad.

Note: Interenteric adhesiolysis should only be performed in case of pertinent complaints

Dissect the anterior fascia epifascially and sparingly. This facilitates the subsequent dissection of the tissue for the mesh bed and later fascial closure.

Starting at the margin of the fascia, incise the rectus sheath on both sides of the linea alba, thereby opening up the retromuscular space, and mobilize the tissue up to the lateral margin of the rectus sheath. Open up the rectus sheath as far mediad as possible because this will preserve sufficient anterior fascia for the planned fascial closure. During subsequent dissection in the lateral direction carefully preserve the segmental vascular branches of the epigastric vessels as much as possible.

On both sides the goal is to prepare an area large enough for a sufficient mesh bed.