E-TEP surgery for ventral hernias: A novel and effective approach to postoperative analgesia

Daniel Mariano de Andrade; Fernando Ponce Leon; Nathalia Barros Oliveira Santos; Jessica Pereira Manso; Luisa Delegave Penedo; Matheus Wanderley Cunha Fernandes Costa; Arnaldo Couto; Fernando Athayde Veloso Madureira

doi:10.4103/ijawhs.ijawhs_75_24

International Journal of Abdominal Wall and Hernia Surgery ›› 2025, Vol. 8 ›› Issue (1) :21 -28. DOI: 10.4103/ijawhs.ijawhs_75_24

Original Article

E-TEP surgery for ventral hernias: A novel and effective approach to postoperative analgesia

Daniel Mariano de Andrade ¹^,^†
, Fernando Ponce Leon ²
, Nathalia Barros Oliveira Santos ²
, Jessica Pereira Manso ³
, Luisa Delegave Penedo ¹
, Matheus Wanderley Cunha Fernandes Costa ¹
, Arnaldo Couto ⁴^,⁵
, Fernando Athayde Veloso Madureira ¹^,⁶

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Abstract

INTRODUCTION: Ventral hernia (VH), associated with diastasis rectus abdominis, is a relatively common pathology in general surgery. Extended-view Totally Extraperitoneal Technique (e-TEP) is a promising surgical technique for its correction. However, it requires extensive dissection and, therefore, can cause postoperative pain. The aim of this study is to propose a new technique for analgesia and to compare it to existing techniques.

MATERIALS AND METHODS: Thirty patients were submitted to VH and diastasis correction surgery applying e-TEP technique and randomly divided into three groups, according to the type of analgesia administered: general anesthesia (GA) alone; GA and TA plane block guided by ultrasound (US-TAPB); GA and TAPB by direct laparoscopic view (DV-TAPB). Pain scores using the Numeric Rating Scale were collected at 2, 6, and 24h postop. The time to administer local anesthetic (LA) was also measured.

RESULTS: No significant differences for gender, age, or body mass index (BMI) were observed, nor for the mean defect area and diastasis length, mesh size, and operation time between groups. The DV-TAPB group presented the lowest pain scores at 2h (P = 0.001), 6h (P = 0.02), and 24h (P = 0.01) postoperatively. Additionally, the mean time required to administer the LA was significantly lower in the DV-TAPB group (1.9min) compared to the US-TAPB group (11.8min).

CONCLUSION: E-TEP is a relatively new and promising technique to treat VH and diastasis. Additional analgesia by DV-TAPB is faster and offers better pain relief in the first 24h postop period.

TRIAL REGISTRATION: http://isrctn.org/ (identifier: ISRCTN11379598).

Keywords

Analgesia / diastasis rectus abdominis / e-TEP / TAP block / ventral hernia

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Daniel Mariano de Andrade, Fernando Ponce Leon, Nathalia Barros Oliveira Santos, Jessica Pereira Manso, Luisa Delegave Penedo, Matheus Wanderley Cunha Fernandes Costa, Arnaldo Couto, Fernando Athayde Veloso Madureira. E-TEP surgery for ventral hernias: A novel and effective approach to postoperative analgesia. International Journal of Abdominal Wall and Hernia Surgery, 2025, 8(1): 21-28 DOI:10.4103/ijawhs.ijawhs_75_24

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