Abstract
In abdominal wall repair, the goal is a functioning abdominal wall strong enough to withstand the forces applied to it every day for life. At the same time, it should not be rigid so that bending, twisting, and distension remain possible and painless.
Closure of the midline is often quoted as a key step, yet people with a lateral hernia have an intact midline but defective abdominal wall. We like to think of abdominal wall repair as restoring the myotendinous ring, transversely as well as vertically, to restore or at least improve core stability and abdominal wall function.
This chapter describes our technique of peritoneal flap repair of (larger) abdominal wall hernias. For midline hernias, it is firmly based on the more conventional classic Rives-Stoppa repair technique.
The name 'peritoneal flap' is actually a misnomer. The 'hernia sac' is not just peritoneum, but is also composed of scar tissue and attenuated abdominal wall fascia.
It can be thin and peritoneum-like, but usually it is comprised of much stronger tissue, and indeed it can be difficult to pass the needle through and suture the dense scar tissue layer. We refer to this as the hernia sac technique.