AUTHOR=Balachandran Premkumar , Tirunelveli Sivagnanam Subbiah , Swathika V. C. 

TITLE=Hernia Sac Preservation for Prevention of Transversus Abdominis Release in Laparoscopic Extended-Totally Extra Peritoneal Repair of Ventral Hernia: A Minimalistic Solution for a Formidable Challenge

JOURNAL=Journal of Abdominal Wall Surgery

VOLUME=Volume 1 - 2022

YEAR=2022

URL=https://www.frontierspartnerships.org/journals/journal-of-abdominal-wall-surgery/articles/10.3389/jaws.2022.10634

DOI=10.3389/jaws.2022.10634

ISSN=2813-2092

ABSTRACT=Background: The laparoscopic extended – Totally Extraperitoneal (E-TEP) technique of ventral hernia repair is gaining popularity due to advantage of placing a large mesh in the retrorectus plane1. The difficulty of the procedure is compounded by multiple factors. Transversus Abdominis Release (TAR) has gained popularity for reducing the tension of posterior rectus sheath during posterior midline closure in retromuscular repairs3 by adding few centimetres of medial advancement. The main pitfall of TAR is its technical complexity, which may result in morbid complications when implemented incorrectly4.  Hence, to obviate the necessity to perform Laparoscopic TAR in cases of Laparoscopic E-TEP repair of large midline ventral and incisional hernias, we present that the technique of hernial sac preservation be pre-emptively done for all Laparoscopic ETEP repairs so that the necessity of performing TAR in select cases is reduced by aiding in the addition of final crucial centimetres of lengthening to the posterior rectus sheath for achieving posterior midline closure. 
Methods: We hereby report three cases of Ventral hernia repair for whom Laparoscopic E-TEP repair was done and Hernial sac preservation technique was implemented successfully. Midline closure of the posterior rectus sheath was attained under reduced tension
Results: Patients were followed up for up to 6 months postoperatively and were found to have no complications.
Conclusions: In Laparoscopic E-TEP repair of midline ventral hernias, preservation of hernial sac along with the posterior rectus sheath might aid in prevention of performing a TAR in selected cases where posterior layer tension is present.