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J Minim Access Surg. 2019 Apr 24. doi: 10.4103/jmas.JMAS_20_19. [Epub ahead of print]

Retrorectal onlay mesh repair using polypropylene mesh: Cost-effective approach for laparoscopic treatment of ventral abdominal wall hernias.

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Department of Minimal Access Surgery, Vadodara Institute of Gastrointestinal and Obesity Surgery, Vadodara, Gujarat, India.



Laparoscopic repair of ventral abdominal hernias has become a standard of care. The surgery involves placement of a composite mesh with 3-5 cm overlap at the edges of the defect. The disadvantage of this repair is one, the composite mesh used for intraperitoneal placement is quite costly and two, it leaves a foreign body inside the peritoneal cavity, with the potential to cause problems in the future. To circumvent both these issues, we have developed a new approach, called the Retro-Rectal Onlay Mesh (RROM) repair, which allows placement of a plain polypropylene mesh in an extraperitoneal plane.

Patients and Methods:

Patients with paraumbilical hernia and lower midline incisional hernias were included in this pilot study performed at a single centre by the same surgeon. The steps of the technique are described in detail.


Since 2016, a total of 52 patients were operated by this technique, including both male and female patients. It included patients with para-umbilical hernias as well as incisional hernias. The RROM repair could be successfully carried out in all the patients. In six of the patients, transversus abdominis release was added as the defect size was large to allow closure of the defect. The results were satisfactory with a low morbidity and no mortality.


In our opinion, the RROM technique is an important tool in the armamentarium of the laparoscopic surgeon dealing with ventral abdominal hernias, allowing placement of polypropylene mesh in an extraperitoneal space. It allows significant cost savings as compared to the prevalent intraperitoneal onlay mesh repair.


Incisional hernia; laparoscopic ventral hernia repair; para-umbilical hernia; polypropylene mesh; retro rectal onlay mesh repair

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