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Retromuscular Rives-Stoppa Repair

Classical retromuscular abdominal wall reconstruction technique with mesh placement beneath the rectus muscle for large complex ventral hernias.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is Retromuscular Rives-Stoppa Repair?

Rives-Stoppa repair is a retromuscular technique for ventral hernia repair, with mesh placement in the retrorectus space (between rectus muscle and posterior rectus sheath).

Originally described by Jean Rives (1973) and modified by René Stoppa (1989) using a giant prosthetic mesh; Stoppa technique extends mesh placement into the preperitoneal space.

Indications: large midline ventral hernia (>10 cm), recurrent hernia, complex multifocal hernia, swiss-cheese hernia, bilateral inguinal hernia, parastomal hernia.

Recurrence rate 0.5–5%, well below onlay (10–15%) and primary suture repairs (25–50%); preferred for large and complex defects, particularly with combined component separation.

Symptoms

Preoperative reducible or non-reducible mass on the anterior abdominal wall
Loss of abdominal domain (large defect, >50% intraabdominal volume in hernia sac)
Cosmetic deformity, abdominal protrusion, postural problems
Chronic pain, nausea, vomiting, constipation (mechanical effects)
Mass effect on intraabdominal organs and lower back pain
Recurrent hernia after prior repairs (most common indication)
Postoperative pain at incision and donor sites (transient)
Seroma at retrorectus space (usually small and self-limited)
Mesh complications: chronic pain, infection, migration, fistula (rare with modern materials)

Risk Factors

Obesity (BMI >35 kg/m² increases recurrence and complications)
Diabetes mellitus and hyperglycemia
Active or recent smoking (3–5× higher risk)
Previous wound infection or seroma
Multiple prior abdominal surgeries (mesh history)
Chronic obstructive pulmonary disease and chronic cough
Connective tissue disorders (Ehlers-Danlos, Marfan)
Chronic constipation, prostatic hypertrophy, ascites (intraabdominal pressure)
Malnutrition, immunosuppression
Use of corticosteroids or immunosuppressive medications

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Painful or enlarging hernia with new symptoms
  • Inability to reduce hernia (incarceration: emergency)
  • Bowel obstruction signs: nausea, vomiting, constipation, abdominal distension (urgent)
  • Skin changes over hernia: discoloration, erythema, ulceration (impending strangulation)
  • Severe chronic pain limiting daily activities
  • Recurrent hernia after previous repair
  • Cosmetic concerns affecting quality of life
  • Postoperative concerns: persistent seroma, wound dehiscence, infection signs

Treatment Methods

01
Preoperative evaluation: detailed history, physical examination, CT abdomen with measurement of defect (length, width, abdominal circumference, hernia sac volume), nutrition status, comorbidity optimization
02
Risk optimization: smoking cessation 4–6 weeks preoperatively, weight loss for BMI >35 kg/m², HbA1c <7%, infection treatment
03
Botulinum toxin injection: preoperative injection into oblique muscles to relax abdominal wall, particularly in loss of domain (4–6 weeks preoperatively)
04
Progressive pneumoperitoneum: in severe loss of domain (>50% intraabdominal volume in hernia), gradual abdominal expansion
05
Anesthesia: general anesthesia, prophylactic antibiotics (cefazolin), thromboprophylaxis
06
Surgical technique — Rives: midline laparotomy, hernia sac dissection, posterior rectus sheath opening up to linea semilunaris, retrorectus space dissection, mesh placement (usually polypropylene 20×20 cm or larger), closure of posterior sheath, closure of anterior fascia
07
Stoppa modification: extension of mesh placement into preperitoneal space, especially below arcuate line; covers the entire visceral sac; useful for bilateral or multifocal hernias
08
Mesh selection: polypropylene (most common, low cost, durable), polyester, ePTFE (for intraperitoneal placement), biological mesh (for contaminated cases), absorbable mesh (rare cases)
09
Mesh size: 5 cm overlap of defect borders; preference for large mesh (≥30×30 cm) in complex cases
10
Component separation combination: TAR (transversus abdominis release) for greater fascial mobility in large defects
11
Drain placement: closed-suction drains in retrorectus space, removed when output <30 mL/day
12
Postoperative care: early ambulation, pain control with multimodal regimen, abdominal binder, gradual return to activity
13
Antibiotic prophylaxis: single-dose preoperative; 24-hour postoperative continuation in selected cases
14
Recovery time course: hospital stay 3–5 days, return to light activity 2–4 weeks, full recovery and lifting >5 kg in 6–12 weeks
15
Complications: surgical site infection (5–15%), seroma (10–30%), hematoma (3–5%), wound dehiscence (1–3%), bowel injury (rare), mesh infection (1–3%), chronic pain (5–10%)
16
Recurrence rate: 0.5–5% with proper technique; higher in obesity, smoking, large defects (>15 cm)
17
Long-term outcomes: excellent functional and cosmetic outcomes; high patient satisfaction
18
Follow-up: outpatient assessment at 1, 4, 12 weeks, then annually; CT for suspected recurrence
19
Multidisciplinary follow-up: hernia surgery, plastic surgery (for complex skin closure), nutrition (preoperative optimization), physiotherapy (postoperative rehabilitation)

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You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.