Enhanced-view totally extraperitoneal approach in emergency ventral incision hernia repair: a case report

The rate of emergency operations for incarcerated and strangulated ventral hernias is about 10-15% with worse outcomes than elective surgery. A recent laparoscopic technique called Enhanced view totally extra peritoneal approach (eTEP) was shown to be indicated in elective repair of ventral and incisional hernias and it has been shown to have lower rate of postoperative morbidity compared to the Rives-Stoppa technique, while having the same indications. However the eTEP laparoscopic technique has not been yet reported in emergency ventral hernia repair.     We report the case of a 57 years old white male, with history of multiple abdominal interventions by laparotomy, admitted in the emergency department with vomiting and periumbilical pain progressing since 3 days.  On clinical examination, we find a strangulated incisional para-umbilical hernia with local cellulitis and tenderness in the right flank. Abdominal CT scan confirm the diagnostic and some signs of thickening of intestinal wall and multiples ventral hernias.  The patient was admitted and operated the same day by the eTEP technique without necessity of intestinal resection. The patient was discharged at postoperative day 5. The main complication was the presence of seroma diagnosed and drained by an extra peritoneal laparoscopy after 3 weeks. Total resolution of seroma was confirmed at 1 year follow up. Incarcerated and strangulated ventral hernias are still classically treated by laparotomy.This case report shows for the first time that the eTEP procedure can be applied for abdominal wall surgeries also in emergency setting in selected patients. We hypothesize that this new procedure can be a promising approach leading less postoperative complications and shorter hospital stays.