This case describes a 58-year-old man who developed a symptomatic incisional ventral hernia following a trauma laparotomy and left nephrectomy after a motor vehicle collision. The patient presented with multiple midline hernia defects associated with bulging and discomfort. This video demonstrates a robotic transabdominal preperitoneal (rTAPP) repair with mesh. The case highlights practical strategies for managing intra-abdominal adhesions and a prior gastrostomy site, while outlining alternative operative approaches for cases in which preperitoneal flap development is technically challenging.
A 55-year-old female has a history of multiple abdominal surgeries including laparoscopic cholecystectomy, appendectomy, laparoscopic hysterectomy, tubal ligations, and multiple cesarean sections through a low transverse (Pfannensteil) incision. Cross-sectional imaging demonstrated multiple midline hernias ranging from 1–3 cm, a rectus diastasis measuring 4 cm wide, and intraparietal cesarean section (C-section) hernia (Zanellato Type II). She underwent a robotic retromuscular extended totally extraperitoneal (eTEP) repair wherein her ventral midline hernias, rectus diastasis, and intraparietal hernia were all repaired and reinforced with wide mesh overlap. This case highlights the strengths of an eTEP approach, the decision making behind considering all of a patient’s abdominal wall pathology, and the considerations with intraparietal hernias post C-section.
A 58-year-old patient underwent robotic bilateral transversus abdominis release (TAR) for repair of a recurrent incisional hernia following prior hernia repair complicated by mesh infection and subsequent explantation. This approach was selected based on the patient’s surgical history, the size of the hernia defect, and the extent of incarcerated small bowel. A double-docking technique was employed to facilitate bilateral TAR, and a large macroporous polypropylene mesh was placed. This case highlights the operative decision-making involved in complex hernia repair and demonstrates the technical considerations for performing a robotic bilateral TAR.
This video is a comprehensive step-by-step demonstration of laparoscopic inguinal hernia repair using the TEP method. It features a middle-aged male with bilateral inguinal hernias who has experienced left groin pain for several years. This case is significant as it showcases the efficiency of laparoscopic techniques in addressing bilateral hernias, which are relatively common, through a single surgical procedure. The detailed description of the procedure provides valuable insights for surgeons at various stages of their careers. For novice surgeons, it offers a step-by-step guide to the TEP technique, highlighting critical anatomical landmarks and potential pitfalls. Experienced surgeons may benefit from the nuanced discussions on tissue handling, dissection techniques, and mesh placement.
Robotic paraesophageal hernia repair with concurrent LINX device placement represents an evolutionary step in the surgical management of complex hiatal pathology. When performed with appropriate patient selection and attention to technical detail, the procedure offers excellent outcomes with acceptable morbidity. This instructional video will be particularly beneficial for surgeons, surgical trainees, and advanced practice providers seeking to enhance their understanding of the technical aspects of robotic paraesophageal hernia repair with LINX placement, as well as for medical educators teaching complex, minimally-invasive upper gastrointestinal procedures.
Yuri Novitsky’s description of the posterior component separation in 2012 has revolutionized the world of ventral hernia repairs. While large hernia defects above 10 to 12 centimeters seemed impossible to close primarily without tension, the technique of transversus abdominis release as described helped achieve posture as well as anterior abdominal wall closure without tension in addition to providing a highly vascularized medium for mesh integration in between these layers. Not only does the posterior component separation allow for medialization of the posterior rectus sheath to be closed in the midline, but it also gives a release to the anterior components of the abdominal wall to allow for recreation of the linea alba without tension.
An 80-year-old patient underwent an open onlay repair of a recurrent incisional hernia. This approach was chosen due to the patient’s prior retromuscular repair, age, history of adhesions, and religious preference against blood products. Following safe abdominal entry and adhesiolysis, a subcutaneous pocket extending 5 centimeters in all directions from the hernia was created. Fascia was closed using mesh-suture and a 12 x 12-centimeter macroporous, medium-weight polypropylene mesh was secured to the anterior fascia with staples and fibrin glue. A subcutaneous drain was placed. This case highlights the utility of an onlay approach for selected circumstances.
Epigastric hernias, predominantly described in the literature as small defects containing mostly preperitoneal fat, are located in the linea alba between the xiphoid process and the umbilicus. The risk of incarceration in epigastric hernias is influenced by the size of the defect. It has been observed that smaller epigastric hernias, particularly those less than 1 cm in diameter, have a higher risk of incarceration compared to larger ones. Various treatment options are available for epigastric hernias, including laparoscopic and open surgical approaches. This video describes an open epigastric hernia repair without mesh for a 1-cm incarcerated hernia. The technique demonstrated addresses both the correction of the hernia and the prevention of recurrence, which is crucial given the higher incarceration rates associated with smaller hernias. This video demonstration of an open epigastric hernia repair without mesh for a 1-cm incarcerated hernia provides valuable insights for surgical trainees, general surgeons, and hernia specialists. The technique showcased is particularly useful for small epigastric hernias and in cases where a rectus diastasis is present.
Umbilical hernias are common abdominal wall defects that occur when intra-abdominal contents protrude through the umbilical opening in the abdominal muscles. This article focuses on the detailed surgical technique for open umbilical hernia repair without mesh for a 1-cm hernia, emphasizing both functional and aesthetic outcomes. This video demonstration and accompanying description serve as valuable educational resources for surgical trainees, general surgeons, and plastic surgeons seeking to refine their techniques for small umbilical hernia repairs. The step-by-step approach, rationale for each decision, and emphasis on both functional and cosmetic outcomes provide insights that can help surgeons optimize their results in umbilical hernia repair.
This video demonstrates a case involving an open complex abdominal wall reconstruction with transversus abdominis release. The case involves an obese patient with a multiply recurrent incarcerated incisional hernia. The CT scan shows a complex defect involving the midline, right linea semilunaris, and inter-rectus hernia. The use of a retromuscular procedure with a posterior component separation will be highlighted and its advantages of allowing wide mesh overlap without creation of subcutaneous tissue flaps to repair defects with these challenging characteristics.
