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Page 10 of 20 Siegal et al. Plast Aesthet Res 2019;6:25 I http://dx.doi.org/10.20517/2347-9264.2019.35

Figure 7. Pant leg maneuver: the subxiphoid plane is dissected. After the right and left retrorectus spaces are developed, the surgeon’s
fingers can straddle these planes demonstrating the two “pant legs”. The blue arrows show the right and left “pant legs” (linea alba
insertion) that straddle subxiphoid/preperitoneal space (blue star)

with polyglycolic acid, biologic or coated 4-hydroxybuterate mesh if autologous tissue is not available.
Polyglycolic acid mesh is the most inexpensive of the three, and is proven to be safe for such reconstruction
[24]
purposes .
Bilateral TAR should provide enough myofascial advancement to allow the posterior sheaths to meet in
the midline [Figure 9]. If there is undue tension on the midline closure, additional lateral dissection can be
performed bluntly to gain additional midline advancement. The right- and left-hand sides of the posterior
layer are closed in the midline with an absorbable running suture from the superior and inferior ends. If
the midline can be approximated, but is closing with some tension, a locking bite can be performed every
few travels. Prior to closing the mid portion, the countable towel must be removed from the peritoneal
cavity.

Preparation of the sublay space
Any remaining hernia sac is dissected free from the subcutaneous fat. The sac and any unusable fascial
bands are resected, revealing healthy EO fascia at the medial boarder of the RA. Some surgeons routinely
irrigate the retromuscular space with antibiotic lavage solution. The purpose is to reduce the bioburden of