Are Retromuscular Repairs Always the Best Option for Ventral Hernias? Augmented Evidence Review.

Retromuscular utilization increased with defect size, from 5.0% for defects <3cm to 59.2% for defects measuring 5-10cm.

Surgeon polling similarly identified the 5-10cm range as the threshold at which retromuscular repair becomes strongly preferred (67% of respondents).

The AI-literature synthesis reinforced this size-dependent pattern, affirming retromuscular repair's superior recurrence profile for large and complex defects while identifying comparable short-term outcomes with preperitoneal or onlay repair, and lower associated morbidity, for small primary hernias ≤6cm.