Ventral / Incisional Hernia Repair (Open, Laparoscopic, Robotic)

Procedure Snapshot

• Indication: Symptomatic or enlarging abdominal wall defect.
• Expected duration: ___
• Special instruments: Mesh, lap ports, tacker or suture device.

Step Workflow — Open

1. Elliptical excision of scar; dissect to fascia.
2. Free adhesions & reduce contents.
3. Mesh placement (onlay, sublay, or IPOM).
4. Close fascial edges if possible.

Step Workflow — Laparoscopic/Robotic

1. Establish pneumoperitoneum away from defect.
2. Lysis of adhesions; measure defect.
3. Introduce composite mesh with ≥ 5 cm overlap.
4. Fix mesh circumferentially with tackers or sutures.

Key Pimp Questions

• Q: Component separation purpose? Medialize rectus flaps for closure (PMID 31579994).
• Q: Recurrence after lap vs open? Similar if mesh used.

Critical Anatomy

• Landmarks: Rectus sheath, linea alba, semilunar line.
• Danger zones: Epigastric vessels.

Informed Consent Highlights

• Recurrence __ Seroma __ Mesh infection ___

Post-op Considerations

• Binder support; avoid strain ≥ 6 weeks.

References

• Chassin’s, Hernia chapter. Clinical Scenarios, Abdominal Wall.
• Rosen 2019 (PMID 31579994).