Alternative to mesh repair for ventral hernias: Modified rectus muscle repair

Figure 1 Rectus muscle repair technique. A: The suture engages full thickness of rectus abdominis muscle and its anterior and posterior sheaths; B: When pulled together, the recti assume a midline position, inverting the attenuated linea alba and hernia sac.

Figure 2 The hernia sac and attenuated linea alba are inverted by placing full-thickness sutures to approximate the rectus abdominis muscles (arrows). A: The sutures incorporate the anterior and posterior sheaths en masse including the medial 1-1.5 cm of the muscle; B: All attenuated midline tissues are therefore eliminated (by inverting them).

Figure 3 Relaxing incisions are made in the anterior rectus sheath in order to reduce tension on the suture line.