Incisional hernia repair with open, retromuscular mesh augmentation

The existing skin scar is completely excised.

Preparation down to the fascia and exposure of the entire fascial scar.

The abdominal cavity is opened in the area of the hernia sac, with the fascial scar being completely transected. It is not sufficient to only repair the fascial defect, as there are often additional defects along the course of the fascial scar in the form of a mesh hernia.

The local adhesiolysis of visceral organs from the hernia sac and the adjacent abdominal wall allows for better visualization, preventing iatrogenic bowel lesions during further preparation of the omental bed. Subsequently, the abdominal cavity is protectively covered with a warm, moist cloth.

Note: An inter-enteric adhesiolysis should only be performed if there are corresponding symptomatic complaints.

A careful epifascial preparation of the anterior fascia is performed, including the hernia sac. This facilitates the subsequent preparation of the mesh bed and the later closure of the fascia.

Incision of the rectus sheath from the fascial edge on both sides of the linea alba with opening of the retromuscular space and mobilization up to the lateral edge of the rectus sheath. The opening of the rectus sheath should be as medial as possible to obtain sufficient anterior fascia for the planned fascial closure. During further lateral dissection, attention should be paid to the segmental vascular connections of the epigastric vessels and these should be preserved if possible. The goal is to prepare a sufficiently large mesh bed on both the left and right sides.