{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T11:10:07Z","timestamp":1756379407339,"version":"3.44.0"},"reference-count":18,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,1,16]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:p>The recurrence of large (&gt;8\u2009cm width) incisional hernias remains a challenging problem in surgical practice. We present a case report of a large recurrent incisional hernia following multiple prior procedures. The patient underwent a tension-free hernia repair using the hernia sac as a peritoneal flap. The surgical approach involved careful dissection and mobilisation of the hernia sac, which was then used to create peritoneal flaps on the anterior and posterior aspects of the mesh. This technique obviated the need for traditional component separation procedures, thereby preserving the integrity of the abdominal musculature. An intraoperative video is included to elucidate the procedural steps, demonstrating the meticulous handling of anatomical layers of the abdominal wall during peritoneal flap repair. This case highlights the efficacy of peritoneal flap repair as a viable alternative for managing large ventral hernias.<\/jats:p>","DOI":"10.1136\/bcr-2024-262460","type":"journal-article","created":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T12:05:35Z","timestamp":1738325135000},"page":"e262460","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Peritoneal flap repair for large (&gt;8\u202fcm width) recurrent incisional ventral hernia"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5061-0902","authenticated-orcid":false,"given":"Vikram","family":"Saini","sequence":"first","affiliation":[{"name":"Department of Surgical Discipline, All India Institute of Medical Sciences Bathinda, Bathinda, PB, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sonali","family":"Alla","sequence":"additional","affiliation":[{"name":"Department of Surgery, Maharaja Agrasen Medical College, Agroha, Haryana, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megha","family":"Saini","sequence":"additional","affiliation":[{"name":"Anesthesia, Pandit Madan Mohan Malviya Hospital, Delhi, Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Varsha","family":"Khatri","sequence":"additional","affiliation":[{"name":"Department of Surgery, Maharaja Agrasen Medical College, Agroha, Haryana, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,1,31]]},"reference":[{"key":"2025082803491718000_18.1.e262460.1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-200301000-00018"},{"key":"2025082803491718000_18.1.e262460.2","doi-asserted-by":"publisher","DOI":"10.1089\/sur.2015.124"},{"key":"2025082803491718000_18.1.e262460.3","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1097\/SLA.0000000000001673","article-title":"Outcomes of Posterior Component Separation With Transversus Abdominis Muscle Release and Synthetic Mesh Sublay Reinforcement","volume":"264","author":"Novitsky","year":"2016","journal-title":"Ann Surg"},{"key":"2025082803491718000_18.1.e262460.4","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.jss.2015.12.014","article-title":"Sublay versus underlay in open ventral hernia repair","volume":"202","author":"Holihan","year":"2016","journal-title":"J Surg Res"},{"key":"2025082803491718000_18.1.e262460.5","doi-asserted-by":"crossref","first-page":"1452","DOI":"10.1002\/bjs.6728","article-title":"Nationwide study of early outcomes after incisional hernia repair","volume":"96","author":"Bisgaard","year":"2009","journal-title":"Br J Surg"},{"key":"2025082803491718000_18.1.e262460.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2010.01.008"},{"key":"2025082803491718000_18.1.e262460.7","doi-asserted-by":"crossref","unstructured":"Beaux AC , East B . Peritoneal Flap\/Hernia Sac Technique for Midline Ventral Hernia. Singapore: Springer Nature Singapore, 2022:65\u201375.Available: https:\/\/doi.org\/10.1007\/978-981-19-5248-7_7 doi:10.1007\/978-981-19-5248-7_7","DOI":"10.1007\/978-981-19-5248-7_7"},{"key":"2025082803491718000_18.1.e262460.8","doi-asserted-by":"crossref","unstructured":"East B . De beaux ac (2022) peritoneal flap\/hernia sac technique for transverse ventral hernia. In: Baig SJ , Bhandarkar D , Priya P , eds. Newer concepts and procedures in hernia surgery - an atlas. Singapore: Springer Nature Singapore, 2022: 77\u201382.","DOI":"10.1007\/978-981-19-5248-7_8"},{"key":"2025082803491718000_18.1.e262460.9","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1007\/PL00012326","article-title":"Regeneration of abdominal wall aponeurosis: new dimension in Marlex peritoneal sandwich repair of incisional hernia","volume":"23","author":"Matapurkar","year":"1999","journal-title":"World J Surg"},{"key":"2025082803491718000_18.1.e262460.10","doi-asserted-by":"crossref","first-page":"2157","DOI":"10.1007\/s00268-019-05011-0","article-title":"Peritoneal Flap Hernioplasty for Reconstruction of Large Ventral Hernias: Long-Term Outcome in 251 Patients","volume":"43","author":"Nielsen","year":"2019","journal-title":"World J Surg"},{"key":"2025082803491718000_18.1.e262460.11","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1007\/s10029-024-02993-2","article-title":"Peritoneal flap technique for abdominal wall expansion in the management of complex ventral hernias: a multicentre study from India","volume":"28","author":"Baig","year":"2024","journal-title":"Hernia"},{"key":"2025082803491718000_18.1.e262460.12","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1177\/1457496919863943","article-title":"Modified Peritoneal Flap Hernioplasty Versus Retromuscular Technique for Incisional Hernia Repair: a Retrospective Cohort Study","volume":"109","author":"Petersson","year":"2020","journal-title":"Scand J Surg"},{"key":"2025082803491718000_18.1.e262460.13","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1007\/s10029-019-02099-0","article-title":"Peritoneal flap hernioplasty for reconstruction of transverse incisional hernias","volume":"25","author":"Nielsen","year":"2021","journal-title":"Hernia"},{"key":"2025082803491718000_18.1.e262460.14","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1007\/s10029-021-02409-5","article-title":"Peritoneal flap hernioplasty for repair of incisional hernias after orthotopic liver transplantation","volume":"26","author":"Nielsen","year":"2022","journal-title":"Hernia"},{"key":"2025082803491718000_18.1.e262460.15","doi-asserted-by":"crossref","unstructured":"Aljohani E . 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