The Swiss-cheese paradox: An unusual cluster of primary ventral hernia defects managed by robotic TAPP

Abstract Primary ventral hernias are common surgical conditions; yet, their fascial morphology rarely deviates from the typical solitary pattern. We report a rare presentation of a primary ventral hernia with multiple umbilical and multiple supraumbilical fascial defects – forming a ‘Swiss cheese’ configuration – in a patient without prior surgery, trauma or connective tissue disorders. Robotic exploration unexpectedly revealed multiple occult fascial defects that were not fully appreciated on pre-operative imaging, underscoring both the diagnostic and therapeutic value of the robotic transabdominal pre-peritoneal approach.