Skip to main content

Advertisement

SpringerLink
Log in

The extended-view totally extraperitoneal (eTEP) approach for incisional abdominal wall hernias: results from a single center

  • Dynamic Manuscript
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The extended-view totally extraperitoneal (eTEP) approach is a promising technique for abdominal wall hernias and has increased in popularity among hernia surgeons in recent years. This study aims to present the results of applying the laparoscopic eTEP approach for incisional abdominal wall hernias (IAWHs).

Methods

This study is a retrospective analysis of a prospectively collected dataset of 30 patients who underwent laparoscopic eTEP for IAWHs between October 2018 and March 2021 (median follow-up of 15 months).

Results

Thirty patients (8 male, 22 female) with a mean age, mean body mass index, and median ASA score of 53.5, 30.8, and 2, respectively, underwent the eTEP procedure for incisional abdominal wall hernias. In total, 11 (36.7%) patients had a recurrent IAWH. Seventeen (56.7%) patients were treated with eTEP RivesStoppa (eTEP-RS), whereas 10 (33.3%) patients needed the eTEP transversus abdominis release (eTEP-TAR) procedure. In three patients, conversions to other procedures (laparoscopic intraperitoneal onlay mesh-plus (IPOM-Plus) and open RivesStoppa) were needed due to intraoperative complications: iatrogenic perforation to the intestine and large peritoneal tear causing loss of the working space. The mean operative time and mean length of stay (LOS) were 203.5 min and 1.5 days for eTEP-RS and 291.5 min and 1.6 days for eTEP-TAR, respectively. Two patients developed asymptomatic seromas, and one patient developed an asymptomatic hematoma; all were treated conservatively. Only one recurrence was observed over the course of the follow-up period.

Conclusions

The eTEP approach is a safe and feasible option for IAWH repair and a valuable addition to the armamentarium of hernia surgeons.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. LeBlanc KA, Booth WV (1993) Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc 3:39–41

    CAS  PubMed  Google Scholar 

  2. Franklin JE, Gonzalez JJ, Glass JL, Manjarrez A (2004) Laparoscopic ventral and incisional hernia repair: an 11-year experience. Hernia 8:23–27. https://doi.org/10.1007/s10029-003-0163-8

    Article  PubMed  Google Scholar 

  3. Chelala E, Thoma M, Tatete B, Lemye AC, Dessily M, Alle JL (2007) The suturing concept for laparoscopic mesh fixation in ventral and incisional hernia repair: mid-term analysis of 400 cases. Surg Endosc Other Interv Tech 21:391–395. https://doi.org/10.1007/s00464-006-9014-x

    Article  CAS  Google Scholar 

  4. Orenstein SB, Dumeer JL, Monteagudo J, Poi MJ, Novitsky YW (2011) Outcomes of laparoscopic ventral hernia repair with routine defect closure using “shoelacing” technique. Surg Endosc 25:1452–1457. https://doi.org/10.1007/s00464-010-1413-3

    Article  PubMed  Google Scholar 

  5. Agarwal BB, Agarwal S, Gupta MK, Mishra A, Mahajan KC (2008) Laparoscopic ventral hernia meshplasty with “double-breasted” fascial closure of hernial defect: a new technique. J Laparoendosc Adv Surg Tech 18:222–229. https://doi.org/10.1089/lap.2007.0112

    Article  Google Scholar 

  6. Liang MK, Subramanian A, Awad SS (2012) Laparoscopic transcutaneous closure of central defects in laparoscopic incisional hernia repair. Surg Laparosc Endosc Percutaneous Tech 22(2):e66–e70. https://doi.org/10.1097/SLE.0b013e3182471fd2

    Article  Google Scholar 

  7. Bittner R, Bingener-Casey J, Dietz U, Fabian M, Ferzli GS, Fortelny RH, Köckerling F, Kukleta J, LeBlanc K, Lomanto D, Misra MC, Bansal VK, Morales-Conde S, Ramshaw B, Reinpold W, Rim S, Rohr M, Schrittwieser R, Simon T, Smietanski M, Stechemesser B, Timoney M, Chowbey P (2014) Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (international endohernia society (IEHS)—part 1. Surg Endosc 28:2–29

    Article  CAS  Google Scholar 

  8. Robinson TN, Clarke JH, Schoen J, Walsh MD (2005) Major mesh-related complications following hernia repair: events reported to the food and drug administration. Surg Endosc Other Interv Tech 19:1556–1560

    Article  CAS  Google Scholar 

  9. Prasad P, Tantia O, Patle NM, Khanna S, Sen B (2011) Laparoscopic ventral hernia repair: a comparative study of transabdominal preperitoneal versus intraperitoneal onlay mesh repair. J Laparoendosc Adv Surg Tech 21:477–483. https://doi.org/10.1089/lap.2010.0572

    Article  Google Scholar 

  10. I Belyansky, HR Zahiri, A Park (2016) Laparoscopic transversus abdominis release, a novel minimally invasive approach to complex abdominal wall reconstruction. Surg Innov 23: 134–141 https://doi.org/10.1177/1553350615618290

    Article  PubMed  Google Scholar 

  11. Daes J (2012) The enhanced view-totally extraperitoneal technique for repair of inguinal hernia. Surg Endosc 26:1187–1189. https://doi.org/10.1007/s00464-011-1993-6

    Article  PubMed  Google Scholar 

  12. Belyansky I, Daes J, Radu VG, Balasubramanian R, Reza Zahiri H, Weltz AS, Sibia US, Park A, Novitsky Y (2018) A novel approach using the enhanced-view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair. Surg Endosc 32:1525–1532. https://doi.org/10.1007/s00464-017-5840-2

    Article  PubMed  Google Scholar 

  13. Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ (2012) Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg 204:709–716. https://doi.org/10.1016/j.amjsurg.2012.02.008

    Article  PubMed  Google Scholar 

  14. Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, Dietz UA, Eker HH, el Nakadi I, Hauters P, Hidalgo Pascual M, Hoeferlin A, Klinge U, Montgomery A, Simmermacher RKJ, Simons MP, Śmietański M, Sommeling C, Tollens T, Vierendeels T, Kingsnorth A (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13:407–414. https://doi.org/10.1007/s10029-009-0518-x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Kroese LF, Gillion JF, Jeekel J, Kleinrensink GJ, Lange JF (2018) Primary and incisional ventral hernias are different in terms of patient characteristics and postoperative complications—a prospective cohort study of 4,565 patients. Int J Surg 51:114–119. https://doi.org/10.1016/j.ijsu.2018.01.010

    Article  PubMed  Google Scholar 

  16. Stirler VMA, Schoenmaeckers EJP, de Haas RJ, Raymakers JTFJ, Rakic S (2014) Laparoscopic repair of primary and incisional ventral hernias: the differences must be acknowledged—a prospective cohort analysis of 1,088 consecutive patients. Surg Endosc 28:891–895. https://doi.org/10.1007/s00464-013-3243-6

    Article  PubMed  Google Scholar 

  17. Bittner R, Bain K, Bansal VK, Berrevoet F, Bingener-Casey J, Chen D, Chen J, Chowbey P, Dietz UA, de Beaux A, Ferzli G, Fortelny R, Hoffmann H, Iskander M, Ji Z, Jorgensen LN, Khullar R, Kirchhoff P, Köckerling F, Kukleta J, LeBlanc K, Li J, Lomanto D, Mayer F, Meytes V, Misra M, Morales-Conde S, Niebuhr H, Radvinsky D, Ramshaw B, Ranev D, Reinpold W, Sharma A, Schrittwieser R, Stechemesser B, Sutedja B, Tang J, Warren J, Weyhe D, Wiegering A, Woeste G, Yao Q (2019) Update of guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (international endohernia society (IEHS))—part A. Surg Endosc 33:3069–3139. https://doi.org/10.1007/s00464-019-06907-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Köckerling F, Schug-Paß C, Adolf D, Reinpold W, Stechemesser B (2015) Is pooled data analysis of ventral and incisional hernia repair acceptable? Front Surg. https://doi.org/10.3389/fsurg.2015.00015

    Article  PubMed  PubMed Central  Google Scholar 

  19. Tasdelen HA, Karapolat B (2020) Extended totally extraperitoneal rives-stoppa technique for incisional hernia repair—a video vignette. Colorectal Dis 22:475

    Article  CAS  Google Scholar 

  20. Ramana B, Arora E, Belyansky I (2021) Signs and landmarks in eTEP rives-stoppa repair of ventral hernias. Hernia 25:545–550. https://doi.org/10.1007/s10029-020-02216-4

    Article  CAS  PubMed  Google Scholar 

  21. Miserez M, Penninckx F (2002) Endoscopic totally preperitoneal ventral hernia repair: surgical technique and short-term results. Surg Endosc Other Interv Tech 16:1207–1213. https://doi.org/10.1007/s00464-001-9198-z

    Article  CAS  Google Scholar 

  22. Schwarz J, Reinpold W, Bittner R (2017) Endoscopic mini/less open sublay technique (EMILOS)—a new technique for ventral hernia repair. Langenbeck’s Arch Surg 402:173–180. https://doi.org/10.1007/s00423-016-1522-0

    Article  CAS  Google Scholar 

  23. Schroeder AD, Debus ES, Schroeder M, Reinpold WMJ (2013) Laparoscopic transperitoneal sublay mesh repair: a new technique for the cure of ventral and incisional hernias. Surg Endosc 27:648–654. https://doi.org/10.1007/s00464-012-2508-9

    Article  PubMed  Google Scholar 

  24. Masurkar AA (2020) Laparoscopic trans-abdominal retromuscular (TARM) repair for ventral hernia: a novel, low-cost technique for sublay and posterior component separation. World J Surg 44:1081–1085. https://doi.org/10.1007/s00268-019-05298-z

    Article  PubMed  Google Scholar 

  25. Gómez-Menchero J, Guadalajara Jurado JF, Suárez Grau JM, BellidoLuque JA, García Moreno JL, Alarcón del Agua I, Morales-Conde S (2018) Laparoscopic intracorporeal rectus aponeuroplasty (LIRA technique): a step forward in minimally invasive abdominal wall reconstruction for ventral hernia repair (LVHR). Surg Endosc 32:3502–3508. https://doi.org/10.1007/s00464-018-6070-y

    Article  PubMed  Google Scholar 

  26. Muysoms F, van Cleven S, Pletinckx P, Ballecer C, Ramaswamy A (2018) Robotic transabdominal retromuscular umbilical prosthetic hernia repair (TARUP): observational study on the operative time during the learning curve. Hernia 22:1101–1111. https://doi.org/10.1007/s10029-018-1825-x

    Article  CAS  PubMed  Google Scholar 

  27. Claus CMP, Malcher F, Cavazzola LT, Furtado M, Morrell A, Azevedo M, Meirelles LG, Santos H, Garcia R (2018) Subcutaneous onlay laparoscopic approach (SCOLA) for ventral hernia and rectus abdominis diastasis repair: technical description and initial results. Arq Bras Cir Dig 31:1–5. https://doi.org/10.1590/0102-672020180001e1399

    Article  Google Scholar 

  28. Juárez Muas DM (2019) Preaponeurotic endoscopic repair (REPA) of diastasis recti associated or not to midline hernias. Surg Endosc 33:1777–1782. https://doi.org/10.1007/s00464-018-6450-3

    Article  PubMed  Google Scholar 

  29. Bittner JG, Clingempeel NL (2018) Hernia repair in the united states: current situation and trends. The art of hernia surgery. Springer International Publishing, New York, pp 115–122. https://doi.org/10.1007/978-3-319-72626-7_11

    Chapter  Google Scholar 

  30. Parker SG, Windsor ACJ (2018) ventral hernia surgery in europe: trends and actual situation. The art of hernia surgery. Springer International Publishing, New York, pp 103–113. https://doi.org/10.1007/978-3-319-72626-7_10

    Chapter  Google Scholar 

  31. Radu VG, Lica M (2019) The endoscopic retromuscular repair of ventral hernia: the eTEP technique and early results. Hernia 23:945–955. https://doi.org/10.1007/s10029-019-01931-x

    Article  CAS  PubMed  Google Scholar 

  32. Penchev D, Kotashev G, Mutafchiyski V (2019) Endoscopic enhanced-view totally extraperitoneal retromuscular approach for ventral hernia repair. Surg Endosc 33:3749–3756. https://doi.org/10.1007/s00464-019-06669-2

    Article  CAS  PubMed  Google Scholar 

  33. Kumar N, Palanisamy NV, Parthasarathi R, Sabnis SC, Nayak SK, Palanivelu C (2020) A comparative prospective study of short-term outcomes of extended view totally extraperitoneal (e-TEP) repair versus laparoscopic intraperitoneal on lay mesh (IPOM) plus repair for ventral hernia. Surg Endosc. https://doi.org/10.1007/s00464-020-07990-x

    Article  PubMed  Google Scholar 

  34. Giurgius M, Bendure L, Davenport DL, Roth JS (2012) The endoscopic component separation technique for hernia repair results in reduced morbidity compared to the open component separation technique. Hernia 16:47–51. https://doi.org/10.1007/s10029-011-0866-1

    Article  CAS  PubMed  Google Scholar 

  35. Novitsky YW, Porter JR, Rucho ZC, Getz SB, Pratt BL, Kercher KW, Heniford BT (2006) Open preperitoneal retrofascial mesh repair for multiply recurrent ventral incisional hernias. J Am Coll Surg 203:283–289. https://doi.org/10.1016/j.jamcollsurg.2006.05.297

    Article  PubMed  Google Scholar 

  36. Sanna A, Felicioni L, Cecconi C, Cola R (2020) Retromuscular mesh repair using extended totally extraperitoneal repair minimal access: early outcomes of an evolving technique—a single institution experience. J Laparoendosc Adv Surg Tech 30:246–250. https://doi.org/10.1089/lap.2019.0661

    Article  Google Scholar 

  37. Köhler G, Kaltenböck R, Pfandner R, Dauser B, Lechner M (2020) Precostal top-down extended totally extraperitoneal ventral hernia plasty (eTEP): simplification of a complex technical approach. Hernia 24:527–535. https://doi.org/10.1007/s10029-019-02076-7

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery, Trabzon Kanuni Training and Research Hospital, Kasustu Mah. Topal Osman Cad. No: 7, Yomra, 61040, Trabzon, Turkey

    Halil Afşin Taşdelen

Authors
  1. Halil Afşin Taşdelen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All steps of the submitted article were performed by HAT.

Corresponding author

Correspondence to Halil Afşin Taşdelen.

Ethics declarations

Disclosures

Halil Afşin Taşdelen has no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (MOV 864454 KB)

Supplementary file2 (TIF 2883 KB)

Supplementary file3 (TIF 4968 KB)

Supplementary file4 (TIF 6011 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Taşdelen, H.A. The extended-view totally extraperitoneal (eTEP) approach for incisional abdominal wall hernias: results from a single center. Surg Endosc 36, 4614–4623 (2022). https://doi.org/10.1007/s00464-021-08995-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-021-08995-w

Keywords

Search

Navigation