Cranial preperitoneal extension of the retromuscular repair in midline hernias: The Madrid Rives technique.

Abstract

<h4>Purpose</h4>This is a modification of the original retromuscular approach of Rives-Stoppa-Wantz for midline hernia reconstruction. This novel approach preserves the safety and efficacy of the original one while offering two key advantages: maintaining the anatomical and functional integrity of the cranial portion of the posterior rectus sheath and enabling a wider cranial dissection, essential for achieving greater overlap in M1-M2 hernias.<h4>Results</h4>Between January 2015 and September 2024, 100 patients underwent surgery (82 open, 18 laparoscopic). A total of 19 surgical site occurrences were recorded, of which 7 required procedural intervention. There were 5 cases of surgical site infection, 4 superficial and 1 deep. During a mean follow-up of 24,2 months, 3 CT-scan-confirmed recurrences and 4 cases of bulging were observed.<h4>Conclusion</h4>The MR technique enables safe and effective retromuscular-preperitoneal reconstruction of midline hernias, minimizing recurrences and improving the long-term structural integrity of the abdominal wall.