eTEP-PP for repair of primary midline ventral hernias

Abstract

BACKGROUND: Minimally invasive surgery for hernia repair has advanced significantly, with techniques such as transabdominal preperitoneal repair (TAPP) and totally extraperitoneal repair for inguinal hernias inspiring similar approaches for ventral and incisional hernias. The enhanced-view totally extraperitoneal repair (eTEP) technique, introduced in the twenty-first century, demonstrated advantages in inguinal hernia repair. Leveraging the benefits of eTEP and TAPP while addressing their limitations, we developed the extended totally extraperitoneal preperitoneal repair (eTEP-PP) technique for primary midline ventral hernias. This technique combines the benefits of eTEP and TAPP, avoids specific drawbacks such as the need to divide the posterior rectus sheath or close the peritoneum, and ensures safer and more effective repair. The eTEP-PP method shows promise as a future standard for small-to-medium primary ventral hernia repairs. Further studies are needed to confirm its long-term efficacy and application.

MATERIALS AND METHODS: This retrospective study included 15 patients who underwent eTEP-PP surgery between February 2024 and June 2024 at the Department of Surgical Gastroenterology, Regency Hospital, Kanpur, Uttar Pradesh, India. Patients with primary midline ventral abdominal wall hernias were studied, noting intraoperative and postoperative outcomes.

RESULTS: All 15 patients experienced no intraoperative complications or conversions to open surgery. Two patients required conversion from eTEP-PP to eTEP due to challenges in creating the preperitoneal flap. Postoperative outcomes were excellent, with no surgical site occurrences or complications requiring intervention. There were no readmissions, mortalities, or recurrences 1 month post-surgery.

CONCLUSION: The eTEP-PP technique for primary ventral hernia repair is reproducible and has shown excellent initial outcomes. While the study’s sample size is a limitation, the technique’s potential as a future standard for small-to-medium primary ventral hernia repairs is evident. Further studies are needed to establish its long-term efficacy and broaden its application.

Keywords

eTEP-PP / eTEP-RS / laparoscopic / PeTEP / ventral hernia / ventral TAPP

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2024 2024 International Journal of Abdominal Wall and Hernia Surgery | Published by Wolters Kluwer - Medknow