e-TEP repair for midline primary and incisional hernia: technical considerations and initial experience

Area of Science:

• Abdominal Wall Reconstruction
• Minimally Invasive Surgery
• Hernia Repair

Background:

• Large, complex ventral hernias pose repair challenges.
• The Enhanced-View Totally Extra Peritoneal Rives-Stoppa (e-TEP-RS) technique offers an anatomical mesh placement distinct from the abdominal cavity.
• e-TEP-RS aims to overcome limitations of Intra Peritoneal Onlay Mesh (IPOM) repairs.

Purpose of the Study:

• To present initial experience with the e-TEP-RS technique for large, complex ventral hernias.
• To detail technical modifications for overcoming procedural challenges.
• To evaluate outcomes including post-operative pain, morbidity, Quality of Life (QoL), and recurrence.

Main Methods:

• Retrospective review of 58 patients with midline, large, complex ventral hernias.
• Patients underwent e-TEP-RS with or without Transversus Abdominis Release (TAR).
• Outcomes assessed included post-operative pain, operative morbidity, readmission, QoL, and hernia recurrence.

Main Results:

• No intraoperative morbidity observed in 58 patients.
• Mean surgery duration was 156.2 minutes with 40.5 cc blood loss.
• Quality of Life scores improved significantly; 20.7% experienced major complications (seroma, ileus), and one recurrence was noted.

Conclusions:

• e-TEP-RS is a viable technique for large, complex ventral hernias with excellent results and acceptable morbidity.
• Mastery of the technique on smaller hernias is recommended before complex cases.
• The technique allows anatomical mesh placement, distinct from the abdominal cavity.