Technique: Posterior Rectus Sheath Release

Approximately 4–5 million laparotomies are performed each year in the United States, 2–20% of which are complicated by incisional hernia (IH) [1]. IH is the most common complication of laparotomy requiring reoperation at a ratio beyond bowel obstruction of 3:1 [2]. The vast majority of hernias develop 6 months to 3 years after laparotomy and are associated with wound infection, obesity, tobacco abuse, immune suppression, and suture closure technique [3, 4]. As such, roughly 200,000 incisional hernia repairs are performed annually with a recurrence rate of 45–50% inclusive of all techniques and 20–30% with mesh repair in all-comers [1, 5, 6]. Factors impacting the success of operative repair include management and optimization of medical comorbidities (i.e., obesity, diabetes, smoking, pulmonary function, MRSA colonization) [2]. Tension-free mesh repair is currently the accepted standard of care given prohibitively high recurrence with suture repair alone [1, 6]. However, despite the groundbreaking work of many herniorrhapists over decades of research, the gold standard of mesh herniorrhaphy remains subject to debate [2].