Rectus repair for midline ventral abdominal wall hernia.

Recurrence-free repair of midline ventral abdominal wall hernia continues to elude surgeons, despite the abundance of described techniques. Based on the observation that spontaneous herniation through the rectus abdominis muscles is unknown, a new technique of repair was devised. The rectus muscles and their sheaths on either side of the hernial defect are directly brought together to obliterate the hernia, the intervening linea alba and intact hernia sac being 'keeled' into the abdominal cavity. Using this technique, 85 consecutive midline abdominal hernias were repaired over an 11-year period. Follow-up was from 18 months to 12 years; there was one recurrence. The rectus repair is recommended as an effective method of dealing with ventral midline abdominal wall hernia.