Extended Totally Extraperitoneal (eTEP) Approach for Ventral Hernia Repair: Initial Results

Abstract

Introduction: Since the first laparoscopic incisional hernia repair, several minimally invasive procedures have been developed in abdominal wall repair. In 2017, the extended totally extraperitoneal (eTEP) approach for abdominal wall repair was published. We present the results from eTEP implementation at two medical centers by one surgeon. Methods: Prospective descriptive study of the implementation of the eTEP approach, with transversus abdominis release (TAR) when needed. The surgical technique was initiated by accessing the space between the rectus abdominis muscle and posterior rectus sheath, connecting this space with the fatty preperitoneal space at the midline and the contralateral retrorectal space. Identification and dissection of the hernia sac is performed in the created cavity. Additionally, posterior component release in a TAR fashion could be done. Finally, closure of posterior plane and linea alba is completed and mesh prosthesis is deployed along the whole dissected space. Results: Forty patients underwent an eTEP procedure with 20 supraumbilical defects, 10 infraumbilical and 10 lateral hernias. Sixteen cases required a TAR technique. Mean operative time was 126 min. Median pain reported the first postoperative day was 3 on the visual analog scale. Median length of stay was 1 day and mean follow-up was 10 months. Only one patient developed recurrence, and two patients underwent reoperation. Conclusions: Implementation of eTEP in abdominal wall repair is safe. Preliminary outcomes of the eTEP approach in ventral hernia repair show good pain control with less hospital stay.