Behind the knife

Extended preperitoneal approaches to address ventral hernias is a concept that has been explored more in recent years. We review our approach for moderate sized defects, with bilateral docking during transabdominal preperitoneal hernia repair. To facilitate closure of the defect, we augment the operation with bilateral rectus aponeuroplasty. After fascial closure, we reinforce the closure with a 30 cm x 30 cm macroporous polypropylene mesh.