When to stay out of the abdomen: Extending extraperitoneal approaches to complex ventral and incisional hernias-A video-based guide to the technique

J Trauma Acute Care Surg. 2021 Aug 1;91(2):e55-e58. doi: 10.1097/TA.0000000000003111.


Background: Ventral and incisional hernias are common surgical pathologies managed by acute care surgeons and also an area of exploration in repair options and approaches. Several new minimally invasive techniques have been developed to better tailor the repair to the individual patient and minimize the risk of intra-abdominal complications, particularly in patients with significant adhesions from prior surgery or trauma. The extended totally extraperitoneal approach to incisional ventral hernias allows the repair of complex hernias while entirely avoiding entry into the peritoneal cavity.

Methods: We present video clips demonstrating key steps to minimally invasive extended totally extraperitoneal Rives-Stoppa and transversus abdominis release procedures to complex incisional and ventral hernias.

Conclusion: The application of robotic-assisted laparoscopic surgery has enabled surgeons to expand the use of minimally invasive techniques for a variety of operations. Hernia repair in particular has seen the most rapid growth because of the enhanced ability to suture on the anterior abdominal wall. This video illustrates the key technical points to performing a safe and effective repair without the need for intraperitoneal access.

Publication types

  • Video-Audio Media

MeSH terms

  • Abdominal Wall / surgery*
  • Hernia, Ventral / surgery*
  • Humans
  • Incisional Hernia / surgery*
  • Laparoscopy / methods*
  • Robotic Surgical Procedures / methods*
  • Surgical Mesh