Abdominal wall defects that are amenable to direct fascial approximation are the indication for retromuscular mesh augmentation. Larger defects can be bridged with meshes used as abdominal wall substitution or with reconstructive flaps. Other options are indirect techniques to achieve primary preparation of the abdominal wall, either by mobilization of the abdominal wall muscles with the component separation method or by preoperative expansion of the abdominal cavity using a progressive pneumoperitoneum. Surgical repair of iatrogenic abdominal wall relaxations should combine plastic reconstruction with preperitoneal mesh implantation. Scientific evidence supporting any treatment option is weak, because few prospective, randomized trial data are available owing to the inhomogeneity of the patient population. Treatment of abdominal wall defects must therefore be proposed on an individual basis utilizing one or a combination of the techniques described.
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