Precostal top-down extended totally extraperitoneal ventral hernia plasty (eTEP): simplification of a complex...

Area of Science:

• Laparoscopic surgery
• Hernia repair
• Surgical technique innovation

Background:

• Retromuscular mesh augmentation is the gold standard for ventral hernia repair.
• Laparoscopic enhanced view totally extraperitoneal plasty (eTEP) is effective but technically demanding.
• A need exists for simplified eTEP techniques requiring less surgical expertise.

Purpose of the Study:

• To develop and evaluate a simplified technical modification of the eTEP procedure for ventral hernia repair.
• To assess the feasibility and outcomes of a novel precostal, top-down eTEP approach.
• To streamline the complex dissection and access required for retromuscular mesh placement.

Main Methods:

• A modified precostal, top-down eTEP approach was used in 31 ventral hernia patients.
• A standardized precostal access and bilateral retromuscular compartment development with a dilating balloon port were employed.
• Demographic, hernia-specific, and perioperative data were collected and analyzed retrospectively.

Main Results:

• Twenty-two primary and 9 incisional hernias were repaired, with an average defect size of 34.5 cm².
• Average operative time was 128 minutes, with one conversion due to peritoneal injury.
• The 8-month follow-up showed no recurrence, with one local infection and one interparietal herniation.

Conclusions:

• The modified precostal access and balloon dilation simplify the eTEP procedure, saving time and facilitating dissection.
• This technique provides a better overview for connecting retro-rectus spaces and allows closure up to the xiphoid.
• The simplified approach enhances the feasibility of complex laparoscopic ventral hernia repair.