Arcuate line hernia repair: a laparoscopic technique with transfascial primary repair and mesh reinforcement

Arcuate line hernias (ALHs) are rare intraparietal hernias, with a prevalence ranging from 1.62% to 2%. These hernias occur at the arcuate line (AL)-a significant anatomical transition zone where the posterior lamella of the internal oblique and transversus abdominis aponeurosis shift from contributing fibres to the posterior sheath to the anterior sheath. Uniquely, ALHs do not present with a palpable defect. Although typically asymptomatic, incarceration and strangulation have been reported. Presently, there is no consensus regarding the optimal repair technique for ALHs, which pose a specific challenge in surgical repair due to the absence of a fascial edge to suture to below the AL, as commonly performed in other abdominal hernia repairs. We report an ALH repaired laparoscopically with transfascial sutures and intraperitoneal onlay mesh. Preoperative findings, imaging, anatomical considerations, and tailored surgical approach are discussed, complemented by an extensive review of the literature.