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Background: In an attempt to avoid mesh-related complications, many authorities have described non-mesh repair of midline ventral hernias. We described rectus muscle repair (RMR) for ventral hernias in 1993, but we noticed that a limitation was the inability to repair large hernia defects. We now describe a modification of this technique that allows it to be used for larger defects.

Methods: We report a case in which the modified RMR was used to repair a large ventral hernia. In the original RMR, sutures were placed through each rectus abdominis to approximate the muscles, thereby obliterating the linea alba and repairing the hernia. In this modification of the RMR, the hernia sac and the linea alba were imbricated and a vertical relaxing incision was made in each anterior rectus sheath, keeping the underlying muscle and posterior sheath intact.

Results: This relaxing incision is a useful modification of the original RMR, especially where there is significant tension on the suture line. This patient had an uneventful recovery with no recurrence on clinical examination at his last clinical review 5 years post-operation.

Conclusion: The modified RMR repair for ventral hernias is an acceptable alternative to mesh repair. It brings a low complication profile and avoids the burden of mesh-related complications.