Behind the knife

eTEP is a wonderful access strategy for many hernia repairs. However, one of its limitations is the management of large central defects in the posterior sheath/visceral sac. In an effort to reduce posterior tension and the possibility of postoperative dehiscence, many surgeons will perform posterior component separation to mobilize more peritoneum and allow for a tension free closure of the posterior. Our team has been utilizing posterior sheath supplements, such as omentum, to reduce the need for transversus abdominis release in patients who we can achieve anterior fascial closure without further retromuscular dissection. This reviews of a case where the omentum was used support our posterior closure.