Behind the knife

Recurrent hernias are a common presentations and have to be dealt with regularly. This case highlights a recurrent ventral hernia repair. The patient previously had a robotic intra-peritoneal mesh repair complicated by recurrence. For the re-do hernia repair, we planned to perform a retrorectus repair. During the operation, we felt that there would be undue tension on the posterior fascial closure and thus opted to extend the dissection with a muscle preserving TAR (aka Madrid modification of TAR). The video highlights strategic utilization of trocars to advance the case efficiently and reviews principles of dissection, reconstruction, and intraoperative decision making.