If large hernia defect >5cm, I repair from here in a modified Rives-Stoppa technique
- Incision in posterior rectus sheath and dissection laterally in retro-rectus plane keepin posterior fascia intact
- Continue in all directions around defect
- Close posterior sheath with 0 PDS continuous suture
- Place mesh in dissected plane on posterior sheath
- Aim for ≥5cm overlap with measure defect edge
- Secure interrupted tacking 3/0 PDS sutures
- Aim for ≥5cm overlap with measure defect edge
- Close anterior fascia sheath over mesh
- This may require utilization of anterior component separation if under tension
- Closed with continuous 0 PDS
- I leave a SC drain if large hernia and significant potential space
- Close skin