Pillar-anchored repair of lateral abdominal wall hernia

"Pillar-anchored repair" involves a wide resurfacing of the lateral abdominal wall. In this case, a wide piece of mesh is placed in the underlay plane that spans the entire lateral abdominal wall and is sutured or anchored to the boundaries of the lateral abdominal wall. These boundaries (costal margins, iliac crest, linea semilunaris, paraspinous fascia) are static structures and serve as pillars of support for the lateral abdominal wall. This repair is a load-bearing approach in which the mesh is sutured to fixed supports and bears the bulk of the forces to reduce the risk of herniation. The rationale for this technique arises from the view that lateral abdominal wall defects are accompanied by denervation injury and consequent weakening of a wider area of musculature adjacent to the defect. If the reinforcing mesh is sutured to weakened musculature, progressive weakening may lead to a recurrent bulge or hernia. The static boundaries provide a stable load-bearing support and can reduce hernia rates.