Transverse Lower Abdominal Incision Research Articles

Abdominoplasty Combined with the Anterior Component Separation Technique for Reconstruction of Midline Large Ventral Hernias: Functional and Aesthetic Outcome Clinical Study

Abstract Background Large midline ventral hernias, diastasis of recti and the associated laxity and abdominal shape deformity, represent aesthetic and functional problems for the patients. So, the surgical treatment of both pathologies at the same time is highly recommended if the patient’s general condition permits. This can be achieved by a comprehensive technique incorporating abdominoplasty performed by a transverse lower abdominal incision into any of the hernia repair techniques. Objective The aim of this study is to evaluate the functional and aesthetic outcome of the combined abdominoplasty and anterior component separation technique in the management of midline ventral abdominal hernias. Patients and Methods This study is a prospective case control study that evaluates both functional and aesthetic outcome of performing abdominoplasty on patients with large midline ventral hernias. This study was conducted between December 2020 to March 2022 at the Plastic Surgery Department, Demerdash University Hospital, Cairo, Egypt. Study consisted of fifteen patients with different presentations of abdominal wall laxity and ventral hernias. Patients were evaluated regarding their age, BMI, degree of rectus diastasis, Pre-operative radiological findings, post Operative complication and hernia reoccurrence, patients’ satisfaction, and the pre-operative and post-operative umbilical measurements were compared. Results and Conclusion The current study showed that Abdomioplasty can be combined with complex hernia repair by anterior component separation technique within the same setting in high-risk patients safely with an excellent functional outcome and acceptable satisfactory aesthetic results. Although, this can be associated with an increased risk of postoperative surgical site complications such as; skin necrosis and wound infection. Patient characteristics associated with the development of complications following anterior component separation combined with abdominoplasty include obesity, previous abdominal procedures and previous pregnancies.

Use of plastic wound retractor at hysterotomy site in prenatal repair of myelomeningocele: a new technique

Objective: To describe the use of a self-retaining thermoplastic polyurethane wound retractor for the management of hysterotomy during prenatal repair of myelomeningocele.Methods: The preliminary experience with 16 consecutive cases of open surgery for prenatal repair of myelomeningocele using a new technique is presented. Under general anesthesia, the gravid uterus was partially exteriorized through a low transverse abdominal incision and a high 3–4-cm midline vertical mini-hysterotomy was performed. After chorioamniotic membranes were opened with scissors, the internal ring of the retractor was placed into the amniotic cavity to compress the chorioamniotic membranes against the internal uterine wall and permit full retraction of the hysterotomy. Once the neurosurgical intervention was completed, the retractor was removed manually and uterine and abdominal incisions were closed using conventional techniques. Intra- and post-operative complications, as well as short-term pregnancy outcomes, were evaluated.Results: Intrauterine surgery was performed at a mean gestational age of 25.3 weeks and all except two of the interventions were completed within 3.0 h. When compared with the technique described in the Management of Myelomeningocele study (MOMS) trial, the use of the retractor was associated with a lower, although statistically nonsignificant, rate of chorioamniotic membrane separation (20/78 (26%) versus 2/16 (13%), respectively), preterm rupture of membranes (36/78 (46%) versus 4/16 (25%), respectively), and persistent oligohydramnios (16/78 (21%) versus 1/16 (6%), respectively) as well as higher gestational age at delivery (34.1 weeks ± 3.1 versus 36.0 weeks ± 1.93, respectively) and birthweight (2383 g ± 688 versus 2790 g ± 529, respectively). There were no intra- or post-operative complications associated with the use of the device. Only one (6%) of the hysterotomy scars was noted to be thin at the time of the cesarean delivery and no cases of dehiscence occurred.Conclusions: The use of a plastic wound retractor at the hysterotomy site provides a less traumatic approach than the conventional technique for the management of the uterine incision during open intrauterine surgery. Our experience with this technique was associated with short-term pregnancy outcomes that are similar and perhaps even superior to the technique reported in the MOMS trial. Because the device is inexpensive, easy to use, and widely available, its use during open intrauterine surgery should be considered. However, further clinical experience is required to reach a definitive conclusion regarding whether this technique should be incorporated into the protocol of prenatal repair of myelomeningocele.

Autologous Rectus Fascia Graft Interposition Repair of Urethrocutaneous Fistulae in Female-to-Male Metoidioplasty Patients

To describe our technique and outcomes using an autologous rectus fascia interposition graft for repair of recurrent urethrocutaneous fistulae (UCF) following metoidioplasty. A circumferential incision is made to the skin surrounding the UCF and carried to the level of the underlying subcutaneous tissues. The inner fistula skin edges are closed with a running 5-0 monofilament absorbable suture to obliterate the urethral side. The length of the urethral wound is measured and an appropriate sized rectus fascia graft harvested from a small transverse lower abdominal incision that is also used for concomitant percutaneous suprapubic tube placement. Prior to outer skin closure with a running 5-0 monofilament absorbable suture, the fascial graft is spread-fixed between the urethra and skin to avoid overlapping suture lines. A 10-French urethral catheter is removed after 10 days and the suprapubic catheter removed after 2-3 weeks. Three patients have undergone repair of recurrent UCF with this technique since February 2017. All patients had undergone metoidioplasty with a mean time to fistula occurrence of 3.2 months. Mean number of prior UCF repairs was 3.0. With a median follow-up since repair of 7.0 months (range 4-8), no patient has reported UCF recurrence. UCF following metoidioplasty is a difficult surgical complication. Fistula closure with interposition of autologous rectus fascia allows for separation of suture lines and encourages healing without extensive reconstruction.

Comparison of dermatomal sensory block following ultrasound-guided transversus abdominis plane block by the lateral and posterior approaches: A randomized controlled trial.

Background and Aims:Ultrasound (US)-guided transversus abdominis plane (TAP) block is used as a part of a multimodal analgesic regimen in the postoperative period. Lateral approach TAP block (LTAP) has been widely used for postoperative analgesia after lower abdominal surgeries. Posterior approach TAP block (PTAP), which is achieved by more posterior blockade of the anterior ramus of the spinal nerve, also provides profound postoperative analgesia after transverse lower abdominal incision. We investigated the dermatomal sensory block following LTAP and PTAP under US guidance.Material and Methods:Twenty-seven adult female patients undergoing the laparoscopic resection of ovarian tumors under general anesthesia were randomly divided into two groups, those receiving LTAP (Group L, n = 14) and those receiving PTAP (Group P, n = 13). Before induction of general anesthesia, all patients were given bilateral TAP blocks with 15 ml of 0.25% levobupivacaine on each side under US guidance, and the sensory blockade was evaluated.Results:The data are expressed as median (interquartile range [IQR]). PTAP produced a median sensory blockade to sharp touch of three dermatomal segments (IQR 3–4), the most cephalad being T-10 (IQR T-9–T-10), whereas LTAP produced blockade of a median of two segments (IQR 2–2, P = 0.002), the most cephalad being T-10 (IQR T-10–T-10, P = 0.005).Conclusions:PTAP produced a sensory block that involved a greater number of dermatomes and involvement of more cephalad dermatome blocked to sharp touch, compared with LTAP under US guidance.

Open and Laparoscopic Colposuspension in Girls with Refractory Urinary Incontinence.

Lower urinary tract symptoms (LUTS) are very common in children. Standard treatments consist of urotherapy, antibiotic prophylaxis, anti-muscarinics, physical therapy, and the treatment of coexisting constipation. A small group of girls also present with stress incontinence or with stress-induced urge incontinence. In cases of persistent LUTS due to congenital bladder neck insufficiency (BNI), surgical treatment might be considered. The aim of this paper is to assess the results of open and laparoscopic colposuspension in children with refractory urinary incontinence (UI). The results of 18 open and 18 laparoscopic consecutive colposuspensions were analyzed. All patients had UI and failed conservative treatment. BNI was proven by repeated perineal ultrasound and video-urodynamic study. The laparoscopic procedure was performed preperitoneally and the open procedure was via a transverse lower abdominal incision. The same postoperative protocol was used in both groups. The mean operation time was 65 min for the open and 90 min for the lap procedure (p < 0.05). Full success was achieved in 7/18 in the open and in 8/18 in the lap group and partial response was seen in 3/18 and in 5/18, respectively (p = 0.64). No intraoperative complications occurred in this cohort. Open and laparoscopic colposuspension can be used to treat refractory UI in children with BNI when non-invasive methods fail.

Pure laparoscopic right anterior sectionectomy for hepatocellular carcinoma with great vascular exposure.

Laparoscopic hepatectomy is a common procedure that has been reported frequently [1-3]. However, laparoscopic resection of tumors located in hepatic segments 5 and/or 8 remains a technically difficult procedure as it requires two transection planes [4]. Furthermore, there are a greater number of hepatic vein and glissonian pedicle branches that require a division as compared to other hepatectomy operations. In this report, we present a pure laparoscopic right anterior sectionectomy (RAS) for hepatocellular carcinoma (HCC). Preoperative imaging showed HCC (3cm× 4cm) in segment 5 [5]. After selective anterior segment inflow occlusion, transection lines were demarcated. Complete Pringle maneuver was performed for 15min intervals five times during hepatic parenchymal transection. The Cavitron Ultrasonic Surgical Aspirator was used for the transection of the hepatic tissue. Small hepatic vein branches along the middle and right hepatic veins and small glissonian pedicles were clipped, sealed and divided with EnSEAL (TM) (Ethicon). iDrive (TM) Ultra Powered Stapling device (Medtronic) was used for the division of tertiary glissonian pedicles. Hanging maneuver was performed for transection of remaining liver parenchyma after complete division of hepatic venous branches. The specimen was removed through the lower abdominal transverse incision using the endocatch bag. Jackson-Pratt drain was left in the operative field. All work was performed with IRB approval. Pure laparoscopic RAS for HCC was performed successfully without intraoperative complications or transfusions. The operation time was 300min, and the estimated blood loss was <200ml. On postoperative day 5, computed tomography scan showed well-perfused hepatic parenchyma. Pathology specimen confirmed 3.2cm×3cm×2.2cm HCC without involvement of surgical resection margins. The patient was discharged on postoperative day 7 without complications. Pure laparoscopic RAS is a feasible operative procedure in patients with tumors located in hepatic segments 5/8.

Postoperative continuous transversus abdominis plane block vs continuous wound infusion of levobupivacaine in females undergoing open gynecologic procedures

IntroductionTransversus abdominis plane (TAP) block is used as a part of multimodal analgesia in decreasing pain of lower abdominal wall incision. Local anesthetic instillation of wounds through subcutaneous or subfascial catheters is used to treat postoperative pain in different types of surgery. The aim of this randomized controlled trial was to study the opioid-sparing effect of these two techniques (if any) compared to placebo in women undergoing gynecologic procedures through transverse lower abdominal incisions.MethodsSeventy-eight ASA I–III patients planned to undergo gynecologic procedures through a transverse lower abdominal incision were randomly divided into three equal groups: Control (C) group (n = 26), Continuous Wound Infusion (CWI) group (n = 26), and continuous transversus abdominis plane block (TAP) group (n = 26). After standardized general anesthetic and before extubation, the patients were given the allocated treatment. A morphine patient-controlled analgesia (PCA) was started postoperatively alongside with the local anesthetic (or placebo) infusion. Cumulative dose of morphine PCA in the first postoperative 48 h was the primary outcome. Secondary outcomes included visual analog pain score (VAS) at rest and on movement and complications of morphine PCA.ResultsThe cumulative dose of morphine PCA in the first postoperative 48 h was higher in control group than in groups CWI and TAP (P < 0.001). However, no significant difference was found between groups CWI and TAP. No significant differences were found among the three groups regarding VAS during rest but TAP group showed less pain scores than groups C and CWI on movement. The three groups were similar regarding morphine side effects.ConclusionContinuous bilateral TAP block and CWI can decrease PCA morphine consumption in the first postoperative 48 h when compared to placebo in women undergoing gynecologic surgery through transverse lower abdominal incision. Continuous TAB block might give better analgesia with movement than CWI.

Minilaparotomy Approach Employing a Küstner Incision for Rectal Cancer Resection: Report of Three Cases

A minilaparotomy approach ( 7 cm) for colorectal cancer resection is feasible and safe. Such minilaparotomy generally employs a small vertical incision. A low transverse abdominal incision (a Kustner incision) has been shown to be associated with cosmetic advantage, less postoperative pain, and fewer wound-complications than the midline incision. We report three cases (75-year-old female, 64-year-old male, and 74year-old female) who underwent anterior resection of rectal cancer via a minilaparotomy approach employing the Kustner incision. No handport or laparoscope was used. The median body mass index was 18.9 (range, 18.3-19.3) kg/m 2 . The rectal tumors were located in the rectosigmoid and the upper rectum. There were no intraoperative complications. The median operating time and operative blood loss were 160 (range, 159-162) min and 80 (range, 30-90) ml, respectively. All tumors were curatively resected. The patients quickly returned to normal function without morbidity or mortality. No patients developed wound-related complications. During a median follow-up period of 27.4 (range, 26.829.0) months, all patients are alive without tumor recurrence. In addition, neither incisional hernia nor nerve damage developed. We conclude that the minilaparotomy approach employing a Kustner incision is a less invasive and an attractive method with a cosmetic advantage for rectal cancer resection in selected patients. ACTA MEDICA NAGASAKIENSIA 53: 51－54, 2008

The Maylard incision: a low transverse incision variant seen in DIEP flap breast reconstruction

A low transverse abdominal incision, most commonly the Pfannenstiel incision, is often used in obstetric and gynecologic surgery. The Maylard low transverse abdominal incision is a rare variant in which the deep inferior epigastric vessels are ligated. This is clinically important and has significant implications for preoperative planning of reconstructive surgery based on these vessels. Four candidates for deep inferior epigastric perforator (DIEP) flap breast reconstruction were identified with a suspected Maylard incision prior to surgery. Preoperative imaging with Duplex ultrasound was important in select cases for identification of vessel patency and direction of flow. Identification of 'high-risk patients allows for appropriate patient counselling and surgical planning.

Subpectoral Breast Augmentation Through the Abdominoplasty Incision

Abdominoplasty and breast augmentation are often performed together, and subglandular augmentation through the abdominoplasty incision has been previously described. Nine cases of subpectoral breast augmentation and abdominoplasty performed through a single low transverse abdominal incision were performed between 2002 and 2005. The selection criteria included women who were healthy, nonsmokers, without true breast ptosis or breast deformity requiring additional shaping. The subpectoral space was accessed and the pectoralis major origins were mobilized under direct vision, and the implant pocket was shaped with the aid of a breast sizer and breast dissector. The mean follow-up was 22 months. The surgical goals were realized in all cases, with no asymmetry or implant-related complications. The standard abdominoplasty incision provides ample exposure for the creation of a subpectoral pocket and precise placement of implants. The procedure should be considered in patients who wish abdominal recontouring and breast augmentation and have minimal ptosis.

Ultrastructural study of severe testicular damage following acute scrotal thermal injury

Aim The scrotum provides an appropriate environment for the testicles that is essential for spermatogenesis. The aim of this study was to investigate the severity of ultrastructural damage to the testicles after acute thermal injury. Materials and methods Twenty male Sprague–Dawley rats weighing 250 ± 20 g were randomly divided into four groups of five rats each (10 testicles in each group). In the sham group, animals were anesthetized, and both testicles were removed through a lower transverse abdominal incision. For animals in the burn induction group, a container filled with boiling water was used. For the T30 group, the scrota were in contact with steam from the boiling water for 30 s. This procedure was the same for the other two groups: the T60 group (60 s of steam contact) and the T90 group (90 s of steam contact). Skin biopsies of scrota and excisional biopsies of both testicles were taken 1 h after burn. Specimens were prepared for immunohistochemical and transmission electron microscopic examinations. Apoptotic and proliferative activity in the testicles and epidermal and dermal damage to the skin were measured. Results Histopathological examination indicated increasing epidermal and dermal damage to the skin in parallel with the length of contact between the scrota and the steam. Increased apoptotic activity was observed in animals after 30 s, testicular degeneration began at 60 s, and a diffuse degeneration was observed at 90 s with a high rate of apoptosis ( P < .005). Conclusion Our findings demonstrate that thermal trauma to scrotal skin directly affects proliferation, the occurrence of apoptotic and necrotic cell death of spermatogenic seria, Sertolli and Leydig cells in testicles. Attempts to protect the testicles from severe thermal damage are essential, when the scrotal skin is affected by the burn.

Fertility-sparing radical abdominal trachelectomy for cervical carcinoma

A laparotomy and a bilateral complete pelvic lymphadenectomy are performed usually via a transverse lower abdominal incision in a similar manner to patients undergoing a radical abdominal hysterectomy. The limits of nodal dissection are the deep circumflex iliac vein caudally and the proximal common iliac artery cephalad. Any suspicious lymph nodes are sent for frozen-section analysis. A fertility-sparing approach should be abandoned if positive lymph nodes are identified. Sentinel lymph node identification is also a reasonable option and may allow for pathologic ultra-staging of these sentinel nodes.

Fascial patch technique for repair of complicated urethrovaginal fistula

Introduction The operative repair of urethrovaginal fistula due to tension-free vaginal tape (TVT) erosion is a challenging task, and coexisting stress urinary incontinence may complicate the situation even further. We present our technique for the repair of recurrent urethrovaginal fistula combined with stress urinary incontinence, occurring after previous removal of an eroded TVT and failed repair of the fistula. Technical Considerations With the patient in the dorsal lithotomy position, an inverted U-shaped incision was cut in the anterior vaginal wall, and a vaginal flap was developed. The Martius flap from the previous repair was identified and separated from the urethra, thereby disclosing a large fistula hole on the left side of the mid-urethra. Because the periurethral tissues were very friable and attenuated, only one-layer closure of the fistula hole with these tissues was feasible. Therefore, we opted to combine a pubovaginal fascial sling with a fascial patch graft, used to reinforce the fistula site. Through a low transverse abdominal incision, a 15 × 2-cm strip of rectus fascia was harvested. A 2 × 2-cm patch of fascia was excised from the strip and transfixed to the periurethral tissues, covering the sutured fistula site. The Martius flap was repositioned over the flap, and a pubovaginal sling procedure was done. The postoperative course was uneventful, the fistula has healed, and the patient regained full continence. Conclusions This technique can be used in complicated urethrovaginal fistula repair when the surrounding periurethral tissues have been devastated and can be combined with pubovaginal fascial sling placement.

Treatment of severe bilateral nerve pain after Pfannenstiel incision

The lower transverse abdominal incision, as described by Hermann Johannes Pfannenstiel, cutting both skin and fascia in a transverse fashion was popularized in 1900. Nerve pain syndromes included invalidating pain involving neuroma formation or scar encasement of the ilioinguinal or iliohypogastric nerves. We report a case of a female patient who developed severe pain at the lateral wound edges of a Pfannenstiel incision. The diagnosis of pain of nerve origin was made by infiltration of local anesthetic, after which the pain immediately vanished temporarily. Only complete excision of the scar and involved part of the nerve stopped the pain.

Abdominal wall metastasis of ovarian carcinoma after low transverse abdominal incision: report of two cases and review of literature

Occurrence of parietal metastases after surgery for a suspect adnexal mass may worsen the prognosis of the disease. However, it is not clear whether abdominal wall metastases is related to specific biologic features or simply to surgical mismanagement involving small incisions and traumatic extraction of the specimen, resulting in direct seeding of cancer cells. We report two cases with development of parietal dissemination of ovarian carcinomas after Pfannenstiel incision. The two patients needed parietal resection to obtain optimal surgical cytoreduction. Pfannenstiel incisions for exploration of suspicious adnexal masses increase the risk of extensive parietal metastasis in case of malignancy because they require reflection of several sheaths of tissue. The parietal extension of the disease may need major parietal resection that can worsen the functional and general outcome of the patients.

Abdominal wall metastasis of ovarian carcinoma after low transverse abdominal incision: report of two cases and review of literature

Occurrence of parietal metastases after surgery for a suspect adnexal mass may worsen the prognosis of the disease. However, it is not clear whether abdominal wall metastases is related to specific biologic features or simply to surgical mismanagement involving small incisions and traumatic extraction of the specimen, resulting in direct seeding of cancer cells. We report two cases with development of parietal dissemination of ovarian carcinomas after Pfannenstiel incision. The two patients needed parietal resection to obtain optimal surgical cytoreduction. Pfannenstiel incisions for exploration of suspicious adnexal masses increase the risk of extensive parietal metastasis in case of malignancy because they require reflection of several sheaths of tissue. The parietal extension of the disease may need major parietal resection that can worsen the functional and general outcome of the patients.

Huge Uterine Tumor in a Postmenopausal Woman

59-year-old, gravida 3, para 3, postmenopausal woman was admitted for transabdominal hysterectomy and bilateral salpingo-oophorectomy because of the finding of a huge (20-week) uterus that was discovered during a physical examination following 1 episode of postmenopausal bleeding. Fractional curettage demonstrated a benign endometrial polyp. The past medical history of this woman included non‐insulin-dependent diabetes mellitus, mild hypertension, and psoriasis balanced and stabilized by medication for the last 2 years. Pelvic ultrasound demonstrated a uterus measuring 10.9 3 12.2 3 11.6 cm and containing a large mass 10.2 3 9.8 3 10.1 cm. Ten months later the uterine size had enlarged further, to 16.4 3 15.2 3 16.7 cm, and its entire cavity was occupied by a tumor with mixed echographic pictures. The patient underwent transabdominal hysterectomy and bilateral salpingo-oophorectomy by lower transverse abdominal incision. The uterus was enlarged, adnexae were normal, and no ascitic fluid was found. The postoperative course was normal, and the woman was discharged on postoperative day 5 in good health.

Huge Uterine Tumor in a Postmenopausal Woman

59-year-old, gravida 3, para 3, postmenopausal woman was admitted for transabdominal hysterectomy and bilateral salpingo-oophorectomy because of the finding of a huge (20-week) uterus that was discovered during a physical examination following 1 episode of postmenopausal bleeding. Fractional curettage demonstrated a benign endometrial polyp. The past medical history of this woman included non‐insulin-dependent diabetes mellitus, mild hypertension, and psoriasis balanced and stabilized by medication for the last 2 years. Pelvic ultrasound demonstrated a uterus measuring 10.9 3 12.2 3 11.6 cm and containing a large mass 10.2 3 9.8 3 10.1 cm. Ten months later the uterine size had enlarged further, to 16.4 3 15.2 3 16.7 cm, and its entire cavity was occupied by a tumor with mixed echographic pictures. The patient underwent transabdominal hysterectomy and bilateral salpingo-oophorectomy by lower transverse abdominal incision. The uterus was enlarged, adnexae were normal, and no ascitic fluid was found. The postoperative course was normal, and the woman was discharged on postoperative day 5 in good health.

Recurrent inguinal hernia repair by open preperitoneal approach.

To evaluate the open preperitoneal hernia repair for safety, testicular complications and recurrence rate. Prospective cohort study. Combined Military Hospital, Muzaffarabad AJ and K from March 1997 to April 2001. Sixty-five consecutive male patients above the age of 25 years, with unilateral recurrent inguinal hernia underwent open preperitoneal hernia repair using polypropylene mesh. Scrotal or irreducible/obstructed hernias were also included in the study. Patients with primary inguinal hernia were excluded from the study. Patients with class 11/111 obesity (BMI > 35) and patients with ASA grade 3 and beyond were also excluded. Preperitoneal space was entered through a transverse lower abdominal incision placed 3 cm above the inguinal ligament. Mesh was anchored using 2/0 polypropylene interrupted sutures. Forty-two patients were operated under spinal while 23 patients had general anaesthesia. Patients were examined on 7th and 12th postoperative day for early complications. Subsequently they were examined at third month, six-month and then yearly for three years. Main outcome measures considered were intra-operative complications, postoperative testicular complications and re-recurrence. Mean age in our study was 51 years. Fifty-one (78.4%) patients had direct while fourteen (21.6%) patients had indirect recurrence. There were two (3%) wound infections. One (1.5%) patient had hematoma formation. Three (4.6%) patients went into urinary retention postoperatively. There was no seroma formation, no case of bladder or intestinal injury. None of the patients developed any testicular complication or chronic residual neuralgia. There was only one (1.5%) case of re-recurrence during second year of repair. Open preperitoneal repair for recurrent inguinal hernia is safe procedure. It effectively eliminates testicular complications and has a very low recurrence rate.

Abdominoplasty repair for abdominal wall hernias.

The objectives of abdominal hernial repair are to reconstruct the structural integrity of the abdominal wall while minimizing morbidity. Current techniques include primary closure, staged repair, and the use of prosthetic materials. Techniques for abdominoplasty include the use of the transverse lower abdominal incision and the resection of excess skin. By incorporating these aspects into hernial repairs, the procedures are made safer and the results are improved. The medical records were reviewed of 123 consecutive patients who underwent hernial repair. Seventy-six of these patients underwent a total of 82 herniorrhaphies using an abdominoplasty approach. This included using a transverse lower abdominal incision with or without extending it into an inverted-T incision. The hernial defect was then identified and isolated. Repair was obtained with primary fascial closure and plication, primary fascial approximation and reinforcement with absorbable Vicryl mesh, or placement of permanent mesh with or without fascial approximation. Overall, 8 of 82 hernias recurred. Most complications were minor and could be managed with local wound care only. Major complications included one enterocutaneous fistula, one occurrence of skin flap necrosis requiring operative debridement and skin grafting, and one delayed permanent mesh extrusion 2 years after repair. The abdominoplasty approach isolates the incision from the hernial defect and repair. This technique is safe with a low risk of complications and a low rate of recurrence. It is particularly helpful in obese patients, in patients with multiple hernias, and in those patients with recurrent hernias.