Operative details
hernia
STERILE, SCAR, ADHESIONS
All steps of the operation were predefined and performed in a standardized surgical procedure. After disinfection and sterile covering of the surgical site, the former skin scar was excised over the total length. The next step was the preparation of the hernia sac and exposure of the fascia defect. The hernia sac was opened, and an incision of the total fascia scar under vision was performed. After dissolving local adhesions to the abdominal wall, the preparation of the mesh layer started with opening the rectus sheath as medially as possible. The retromuscular space was developed at least 5–6 cm to each side. At the cranial and caudal edges of the fascial defect, the posterior rectus sheath was incised on both sides close to the linea alba over a minimum length of 5 cm with preparation of the “fatty triangle.” Below linea arcuata, the preparation is continued in the preperitoneal space, if necessary, extended to the spatium Retzii behind the pubic bone. In the case of defects close to the xyphoid, the preparation is extended into the retroxyphoidal space by dissection of the posterior rectus sheath from the xyphoid [