A 71-year-old man who underwent laparotomy for a benign small bowel tumor 20 years previously, presented with a third recurrence of a ventral hernia extending from pubis to xiphoid.
The old scar was excised and the skin carefully elevated from the underlying hernia sac and retracted rectus muscles laterally. The sac was carefully entered and multiple sutures and fragments of polypropylene and polytetrafluoroethylene (PTFE) mesh were removed in the process of lysing adhesions.
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Using the rim of the peritoneal sac as a guide, the underside of the lateral edges of abdominal wall was freed from bowel back to the lateral edges of the rectus muscle on either side.
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