Posterior Flap Hernioplasty: A Cost-effective Alternative to Transversus Abdominis Release in Complex Ventral Hernias

Summary: Complex ventral hernias remain challenging due to large fascial defects and loss of domain. The posterior flap hernioplasty is a simplified modification of posterior component separation that enables wide preperitoneal mesh placement without extensive dissection or adjunctive techniques. In this retrospective series, 7 patients with midline hernias greater than 10 cm underwent repair using this approach. The mean operative time was 107 minutes, the mean blood loss was 137 mL, and the median hospital stay was 1 day. Postoperative pain averaged 3 ± 1.1, with no systemic complications. One hematoma (14%) and 1 recurrence (14%) occurred at a median follow-up of 6 months. This technique provides a safe, reproducible, and resource-efficient alternative for large midline hernias, achieving tension-free closure and rapid recovery. Further comparative studies are required to validate long-term outcomes and cost-effectiveness.