Retromuscular Sublay Technique for Ventral Hernia Repair

Abstract

Rives and Stoppa described the sublay technique of hernia repair more than half a century ago, but it took almost three decades to become truly appreciated and even longer for its full clinical potential and benefits to be realized. Modifications to the original operation have significantly improved surgical approaches, postsurgical outcomes, and quality of life. The retromuscular approach requires technical expertise and a firm grasp of the anatomy. With constant substitution of the terms sublay, retrorectus, retromuscular, preperitoneal, and Rives-Stoppa throughout the literature, the nuances need to be distinguished to appreciate the surgical planes encountered during the operation. This article explains the origin of the nomenclature while clarifying these terms, describing the technique, highlighting outcomes, and discussing future considerations.

A Preliminary Multicenter Evaluation of Endoscopic Sublay Repair for Ventral Hernia From China

“…There were three conversion: one TAS was converted to TAPE because of insu cient peritoneal ap separation, one TAS was converted to Lap-IPOM because of severe damage to the peritoneum, and one TES was converted to an open procedure because of failure to create a retromuscular space. * Based on incisional hernia classi cation of the European Hernia Society (EHS) [30] † Defect size (cm 2 ) was calculated by area of an ellipse = π × ( length/2 × width/2 )…”

Retro rectus mesh repair for umbilical hernia in adults: a study of 50 cases

“…The traditional Mayo's repair was practised for many years. 7,8 This involved horizontal double breasting of the flaps at the site of the defect. However the recurrence rate with this technique remained quite high which paved the road for mesh repair.…”

“…However the recurrence rate with this technique remained quite high which paved the road for mesh repair. 7 Open mesh repair involves closure of the defect after herniotomy to be followed by onlay mesh placement. However since the mesh lies in the subcutaneous plane, the complication rate is high.…”

“…Migration of the mesh has also been described leading to recurrence. 7 Laparoscopic repair of umbilical hernia is also practised commonly. 6 The mesh is placed from within the peritoneal cavity and fixed with tacks.…”

“…Therefore in totality laparoscopic approach does not confer any great advantage. [7][8][9] The technique practised in the present study is based on the assumption that the midline is deficient and weak. Hence there is a need to recreate a new midline from the adjacent strong aponeurotic structures and reinforce the new midline with a mesh taking into consideration that even the aponeurosis could be weak.…”