V-031 vicryl mesh with atraumatic fixation as a technical resource for difficult posterior closure in e-tep approach

Abstract Aim To present a technical resource as a possible solution to the posterior defect that does not allow primary closure in the e-TEP approach for ventral hernias, and which may represent an alternative to transverse abdominis release. Material and Methods This is a 44-year-old woman with obesity and previous hysterectomy via infraumbilical median laparotomy. She presented with an M3W1 in incisional hernia with a 4 cm defect containing the transverse colon. Results After performing a retromuscular dissection according to the Rives-Stoppa technique, it was found that there was a continuous tear in the most cranial area of the posterior layer, which was not corrected with the primary suture. It was therefore decided to place an absorbable vicryl mesh to cover the defect, fixed atraumatically with cyanoacrylate. Conclusion During a minimally invasive ventral hernia repair, closure of the peritoneal sac can be technically complex. This leads to exposure of the retromuscular polypropylene mesh, which would come into contact with the visceral bundle, and possible herniation of intestinal contents through the posterior defect. In these cases, one of the most proposed option is the release of the transverse abdominal muscle, but it could increase the technical difficulty and surgical time. As an alternative to this, we propose the placement of an absorbable vicryl mesh, covering the defect, fixed atraumatically with cyanoacrylate. This, as shown in this case, ensures posterior coverage of the mesh and does not hinder subsequent extension of the mesh.