Majumder etal. published a series of ERAS after VHR [45]. This ERAS path­way was broader, including both perioperative care and preoperative patient optimi­zation. Preoperatively, obese patients underwent weight loss counseling, though no specic BMI cut-off was used, and the effect of this counseling on actual preopera­tive weight loss was not reported. Additionally, patients with diabetes were required to reach a hemoglobin A1c (HbA1c) of <8. Smoking cessation for at least 1month prior to surgery was mandatory. Intraoperatively, a transversus abdominis plane (TAP) block was performed using liposomal bupivacaine. Postoperatively, patients received hydromorphone PCA, oral oxycodone, oral acetaminophen, diazepam, gabapentin, and non-steroidal anti-inammatories (NSAIDs). Using this compre­hensive ERAS pathway, 100 patients were compared to 100 historical controls. A decreased LOS was observed from 6.1 to 4days, as well as a reduction in readmis­sion rate. An earlier resumption of regular diet, earlier return of bowel function, and earlier progression to oral narcotic analgesia were also seen in the ERAS group. Recently, Jensen and colleagues published on 94 patients of a larger cohort undergo­ing ventral hernia repair with their enhanced recovery after surgery pathway. Length of stay was signicantly reduced after the introduction of enhanced recovery after surgery (median 4, interquartile range 3–6days vs. control 5, 4–7days, P<0.001). There was no difference between the cohorts in the incidence of postoperative com­plications requiring operative intervention (enhanced recovery after surgery 10.6% vs control 10.4%, P = 1.0) or the rate of readmissions (enhanced recovery after surgery 16.0% vs control 12.5%, P=0.635) [53].

The most common defect that results from a denervation phenomenon follows the ank incision that is utilized in a nephrectomy, lumbar sympathectomy or an anterior approach to the lumbar interbody fusion for degenerative disc disease. This can occasionally be seen following viral infections such as herpes zoster or even de novo with no predisposing factors. In these entities, there is no dened fascial edge that is seen with the more common anterior abdominal wall hernia defects. This is due to the broad surface of the denervated musculature that has intact fascia but lacks the reinforcement of healthy muscle tissue. Mesh materials are especially nec­essary for these problems to assure a durable and cosmetically acceptable repair as possible.