Laparoscopic Retromuscular Mesh Repair for the Management of Multiple Abdominal Wall Hernias.

Laparoscopic retromuscular mesh repair (LRMR) is a minimally invasive and effective approach for treating multiple abdominal wall hernias. The goal of this protocol is to provide a reproducible surgical technique for the management of multiple abdominal wall hernias in the era of minimally invasive surgery. Here, we present a protocol to describe laparoscopic retromuscular mesh repair for the management of multiple abdominal wall hernias, enabling tension-free reconstruction and adequate mesh placement through a minimally invasive approach. The key procedural steps include: (1) creation of the retro-rectus space; (2) expansion of the retro-rectus space with exposure of the hernia defects; (3) crossing the midline to develop the contralateral retro-rectus space; (4) transversus abdominis release to further expand the retromuscular plane when necessary; (5) closure of the hernia defects with reconstruction of the posterior rectus sheath; and (6) retromuscular mesh placement with adequate overlap to ensure durable repair. This technique offers a practical and efficient alternative for the repair of multiple incisional hernias and facilitates tension-free anatomical reconstruction. In a representative case involving multiple abdominal wall hernias, the procedure was completed successfully without complications and was associated with favorable postoperative recovery, demonstrating the versatility and feasibility of the approach and highlighting its potential applicability in complex clinical scenarios.