Laparoscopic Extended Totally Extraperitoneal Hernia Repair with Posterior Component Separation with Transversus Abdominis Release for a Recurrent Incisional Hernia

A patient with multiple comorbidities, including hypertension, type 2 diabetes, hyperlipidemia, and edema, and a prior history of abdominal surgery presented to the gastrointestinal department with a recurrent incisional hernia larger than 10 cm. The patient underwent laparoscopic extended totally extraperitoneal (e-TEP) hernia repair under general anesthesia. The bilateral retrorectal spaces were accessed via three trocars, followed by midline crossover in the upper abdomen and caudal dissection along the fascial defect. Due to the large size of the defect and the anticipated tension, posterior component separation (PCS) with transversus abdominis release (TAR) was performed, with careful preservation of the neurovascular bundles running anterior to the head of the transversus abdominis muscle. After separate closure of the posterior and anterior layers using barbed sutures, a mesh was placed in the intercomponent space to avoid direct contact with intraperitoneal structures. Closed-suction drains were placed bilaterally to prevent seroma formation. The procedure was completed successfully, and the patient experienced no complications. The patient was discharged without complications. A follow-up computed tomography scan demonstrated the integrity of the hernia repair, with progressive resolution of fat infiltration and fluid collection. Laparoscopic e-TEP hernia repair with PCS and TAR provides a safe and effective approach for managing complex recurrent incisional hernias. This technique enables tension-free closure with mesh placement while minimizing intra-abdominal complications.