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Hernia sac preservation in large incisional ventral hernia to prevent anterior component release
  1. Vikram Saini,
  2. Rahul Lather,
  3. Sonali Alla and
  4. Himanshi Verma
  1. Surgery, Maharaja Agrasen Medical College, Agroha, Haryana, India
  1. Correspondence to Dr Vikram Saini; vikramsaini2006{at}


Large ventral hernias require complex surgical techniques, such as component separation. We are presenting a case of an incisional hernia measuring 15×8 cm. The hernia was covered with an overlying thin layer of skin and hernia sac. The skin of this layer was densely adherent to the underlying hernial sac. Because of the thin hernial sac and adherent nature of the skin, approximately 3 cm of the hernial sac was preserved. We used this hernial sac as the anterior sheath ‘extension’ for a tension-free closure. Posterior component separation with transverse abdominis muscle release was done to close the posterior layer without tension and to place a 23×16 cm mesh in the retrorectus plane. By using the hernial sac in repair, we avoided anterior component separation and achieved tension-free closure of the anterior layer.

  • General surgery
  • Surgery

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  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content—VS, RL, SA and HV. The following authors gave final approval of the manuscript—VS, RL, SA and HV.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.