Recurrent complex incisional hernia repair by enhanced-view totally extraperitoneal (eTEP) technique

Area of Science:

• Minimally Invasive Surgery
• Abdominal Wall Reconstruction
• Hernia Repair Techniques

Background:

• Large recurrent abdominal wall hernias present significant surgical challenges.
• The enhanced-view totally extraperitoneal (eTEP) approach is an emerging minimally invasive technique for hernia repair.
• Previous mesh placement can complicate recurrent hernia surgery.

Observation:

• A 56-year-old male with a history of epigastric hernia repair (IPOM) presented with recurrent epigastric and umbilical hernias.
• The eTEP approach was utilized for a complex recurrent ventral hernia repair.
• The procedure involved dissection of preperitoneal and retromuscular spaces, division of posterior fascia, and mesh placement.

Findings:

• The eTEP technique was successfully applied in a complex recurrent ventral hernia case with prior mesh.
• The anterior and posterior fascial sheaths were repaired, and a self-gripping polypropylene mesh was placed.
• The patient experienced an uneventful recovery and was discharged on postoperative day 2.

Implications:

• The eTEP approach demonstrates safety and efficacy in treating complex recurrent ventral hernias, even with existing mesh.
• Potential benefits include improved patient mobility, enhanced esthetic outcomes, reduced pain, and shorter hospital stays.
• This case highlights the versatility of the eTEP technique in challenging hernia repairs.