The authors were able to demonstrate up to 10-cm myofascial advancement at the umbilicus with this technique.
This technique involved developing the avascular plane between the external and internal oblique muscle layers through relaxing incisions lateral to the rectus sheath, and became known as the anterior component separation (ACS). performed anatomic studies describing separation of the components of the abdominal wall to allow for medial mobility (myofascial advancement) to close large ventral hernias with restoration of the linea alba. To overcome these limitations, Ramirez et al.
However, despite the great success of this repair, the retrorectus repair does not easily facilitate myofascial advancement and the limited surface area in the retrorectus space prevents wide mesh overlap. With minor modifications, the Rives-Stoppa repair became widely utilized due to well-proven outcomes with low overall morbidity. , who described incisional hernia repair with mesh placed behind the rectus muscle to protect the visceral sac from mesh contact. This was shortly followed by a colleague, Rives et al.
published his original technique of preperitoneal repair of recurrent bilateral inguinal hernias with polyester mesh in 1973. While small ventral defects lend themselves to various techniques of herniorrhaphy, larger, recurrent, and more complex hernias require more nuanced approaches. The major tenants of herniorrhaphy and abdominal wall reconstruction are reduction of the hernia, defect closure, and strengthening the repair with mesh reinforcement.
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