Behind the knife

The retrorectus space is not always available in the setting of incisional hernias. This video highlights a case of an incisional hernia in a patient with an ileal conduit following cystectomy. The ileal conduit aperture was reinforced with retromuscular mesh during their index procedure but they developed an incisional hernia at the midline extraction site. We performed an rTAPP ventral hernia repair with broad mesh coverage. The video highlight how small adjucts like intracorporeal rectus aponeuroplasty (LIRA) can aid in reducing undue tension during defect closure--a proposed TAPP-RA repair.