Behind the knife

Emergency hernia repairs in patients who are poorly optimized for definitive reconstruction are common circumstances managed by general surgeons. This video reviews an emergency hernia repair in a patient presenting with an acute-on-chronic incarcerated ventral hernia. Their BMI was greater than 50 and a retromuscular dissection was contraindicated. We performed an adjunct to traditional IPOM+ to reduce tension on our fascial closure--specifically, robotic-assisted laparoscopic intracorporeal rectus aponeuroplasty.