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Procedure · Retromuscular repair

Rives–Stoppa retromuscular repair.

Mesh placed behind the rectus muscles, with the muscle closed over the top — held in place by the body's own pressure. The workhorse of abdominal wall repair, and the right operation for most ventral and incisional hernias of real size.

The Rives–Stoppa repair places a large sheet of mesh in the space directly behind the rectus muscles — the retromuscular plane — and then closes the muscle back over it. It works because of where the mesh sits: held flat against the wall by the body's own intra-abdominal pressure, protected by muscle on both sides, and kept away from the bowel. The result is a strong, durable repair with a low recurrence rate, which is why it is regarded as the workhorse of abdominal wall surgery.

It is the standard repair for midline ventral and incisional hernias, and the foundation that larger complex reconstructions build on.

Who it suits

  • Midline ventral and incisional hernias of moderate to larger size.
  • Hernias where a durable, well-protected mesh position matters — most of them.
  • As the base technique when a wider defect also needs a muscle release (TAR).

Very small defects may not need it; very wide ones may need a release added. The repair is matched to the defect.

How it's done

  • The hernia sac is dissected and the contents returned to the abdomen.
  • The space behind each rectus muscle is opened to create the retromuscular plane.
  • A large mesh is laid flat in that space, extending well beyond the edges of the defect.
  • The muscle layers are closed over the mesh, restoring the midline of the abdomen.

Why it lasts. A repair fails when it is closed under tension or the mesh is too small or poorly placed. The retromuscular position addresses all three — wide mesh coverage, in a protected plane, with the wall closed over it.

Recovery

This is bigger surgery than a groin repair. Expect a few days in hospital and a gradual return over four to six weeks, with clear limits on lifting while the repair consolidates. Recovery scales with the size of the hernia. A detailed plan is given before surgery.

Risks, honestly

The main issues are wound healing problems and seroma, both more likely in larger repairs and in smokers or patients with diabetes or obesity — which is why preparation matters before surgery. Recurrence is uncommon after a properly planned retromuscular repair but is never zero. All of this is discussed fully beforehand.

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Common questions

Rives–Stoppa repair — answered

A repair that places a large mesh behind the rectus muscles — the retromuscular plane — for ventral and incisional hernias, with the muscle closed over it. It is the workhorse of abdominal wall repair because the body's own pressure holds the mesh in place.
Mesh in that plane is held flat by the body's own pressure and protected by muscle on both sides, giving a strong, durable repair with a low recurrence rate — and keeping the mesh away from the bowel.
Traditionally open, and it remains so for larger hernias. Smaller versions of the same principle can sometimes be done laparoscopically or robotically. The approach follows the defect.
A few days in hospital and a gradual return over four to six weeks, avoiding heavy lifting while the repair consolidates. Recovery scales with the size of the hernia.