Topic: Incisional Hernia - 'Easy case' as daily case: open vs lap, where the mesh, which fixation…in center midline cases

Material & methods: This is a 81 years old lady with hypothyroidism who was operated 3 years ago. In the previous surgery an onlay mesh placement was performed. The patient developed a symptomatic recurrent incisional hernia that impaired her quality of life. The patient was operated under general anesthesia. A Rives procedure was planned. The main goals of the retromuscular repair were achieved and are explained during the video: dissection of the sac delimiting the borders of the defect, removal of the previous onlay mesh that was completely integrated in the scar, dissection of the retromuscular space leaving the posterior sheath attached to the sac, closure of the posterior rectus sheath, dissection of the "fatty triangle" of Conze extending it more than 8 cm from the defect and dissecting the retropubic preperiotoneal space beyond the arquate line. In this case, a large-pore 30 x 20 cm self-gripping mesh made of polyester and polylacti acid was used as tissue reinforcement. The anterior aponeourosis was completely close in the midline without tension. No drains were used.