, Volume 23, Issue 5, pp 945–955 | Cite as

The endoscopic retromuscular repair of ventral hernia: the eTEP technique and early results

  • V. G. RaduEmail author
  • M. Lica
Original Article
Part of the following topical collections:
  1. Forum on primary midline uncomplicated ventral hernia



The aim of this article is to describe the technique and early follow-up results of abdominal wall reconstruction (AWR) by minimally invasive surgery (MIS); it concerns the already described endoscopic (retromuscular) Rives procedure (e-Rives) and posterior component separation with transversus abdominis release (TAR) by endoscopic approach (eTEP-TAR).


This is a prospective study which consists of 60 patients operated on between May 2016 and December 2017 by a single surgeon and monitored until July 2018. This is a heterogenic cohort with different hernia types (lateral, median, combined) which were also treated with different meshes. This material includes physiological and biomechanical issues related to the abdominal wall, the key stages of the operation including port placement strategy.


The group of patients are 55% male, having a mean age of 53.3 years old, mean BMI of 29.3 and median ASA score of 1.83. The majority of the hernia types is represented by incisional hernia (61.7%) located especially on the median side of the abdomen (80%); more than half of them (60%) are reducible. There were 6 (10%) intraoperative complications that lead to four conversions to open or traditional laparoscopic techniques. Postoperative re-admission—two cases: one case with small bowel obstruction, solved by laparoscopic surgery and one case with hemorrhagic gastritis because of non-steroidal anti-inflammatory treatment that required only medical treatment. Quality of life (assessed on a 0–10 scale) evaluating the postoperative pain, normal activity and aesthetics, shows a significant improvement after 2 weeks and 3 months postoperatively compared to the preoperative level. 93.3% of the patients have been monitored and no recurrences after a mean of 15 months have been reported.


A thorough understanding of the anatomy and surgical technique is mandatory. The eTEP approach is a feasible and safe option in MIS ventral hernia repair.


eTEP Ventral and incisional hernia Abdominal wall repair Retromuscular mesh placement TAR 


Compliance with ethical standards

Conflict of interest

The author(s) declare that they have no competing interests.

Ethical approval

The protocol was approved by the ethics committee of the institutions.

Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

All the patients gave the informed consent for procedure and scientific data use as standard in our hospital.


  1. 1.
    Cox TC, Pearl JP, Ritter EM (2010) Rives–Stoppa incisional hernia repair combined with laparoscopic separation of abdominal wall components: a novel approach to complex abdominal wall closure. Hernia 14(6):561–567CrossRefGoogle Scholar
  2. 2.
    Forte A et al (2011) Rives technique is the gold standard for incisional hernioplasty. An institutional experience. Ann Ital Chir 82(4):313–317PubMedGoogle Scholar
  3. 3.
    LeBlanc KA, Booth WV (1993) Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc 3(1):39–41PubMedPubMedCentralGoogle Scholar
  4. 4.
    Bittner R et al (2014) Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS)-part 1. Surg Endosc 28(1):2–29CrossRefGoogle Scholar
  5. 5.
    Miserez M, Penninckx F (2002) Endoscopic totally preperitoneal ventral hernia repair. Surg Endosc 16(8):1207–1213CrossRefGoogle Scholar
  6. 6.
    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(1):173–180CrossRefGoogle Scholar
  7. 7.
    Belyansky I, Zahiri HR, Park A (2016) Laparoscopic transversus abdominis release, a novel minimally invasive approach to complex abdominal wall reconstruction. Surg Innov 23(2):134–141CrossRefGoogle Scholar
  8. 8.
    Belyansky I et al (2018) A novel approach using the enhanced-view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair. Surg Endosc 32(3):1525–1532CrossRefGoogle Scholar
  9. 9.
    Daes J (2012) The enhanced view-totally extraperitoneal technique for repair of inguinal hernia. Surg Endosc 26(4):1187–1189CrossRefGoogle Scholar
  10. 10.
    Novitsky YW (2016) Posterior component separation via transversus abdominis muscle release: the TAR procedure. In: Novitsky YW (ed) Hernia surgery. Springer International Publishing, Cham, pp 117–135Google Scholar
  11. 11.
    Ramirez OM, Ruas E, Dellon AL (1990) ‘Components separation’ method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 86(3):519–526CrossRefGoogle Scholar
  12. 12.
    Rosen MJ (2015) Atlas of Abdominal Wall Reconstruction - ISBN: 9781437727517| US Elsevier Health Bookshop. Chap 11. pp 185–201 [Online]. Accessed 8 Oct 2015
  13. 13.
    De Keulenaer BL, De Waele JJ, Powell B, Malbrain MLNG (2009) What is normal intra-abdominal pressure and how is it affected by positioning, body mass and positive end-expiratory pressure? Intensive Care Med 35(6):969–976CrossRefGoogle Scholar
  14. 14.
    Losken A, Jeffrey J (2012) Advances in abdominal wall reconstruction. Thieme Publishers, New YorkCrossRefGoogle Scholar
  15. 15.
    Muysoms FE et al (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13(4):407–414CrossRefGoogle Scholar
  16. 16.
    Rath AM, Attali P, Dumas JL, Goldlust D, Zhang J, Chevrel JP (1996) The abdominal linea alba: an anatomo-radiologic and biomechanical study. Surg Radiol Anat 18(4):281–288CrossRefGoogle Scholar
  17. 17.
    Nahabedian MY (2016) Diagnosis and management of diastasis recti. In: Novitsky YW (ed) Hernia surgery. Springer International Publishing, Cham, pp 323–336Google Scholar
  18. 18.
    Criss CN, Petro CC, Krpata DM, Seafler CM, Lai N, Fiutem J (2014) Functional abdominal wall reconstruction improves core physiology and quality-of-life. Surgery 156(1):176–182CrossRefGoogle Scholar
  19. 19.
    Kukleta JF, Freytag C, Weber M (2012) Efficiency and safety of mesh fixation in laparoscopic inguinal hernia repair using n-butyl cyanoacrylate: long-term biocompatibility in over 1,300 mesh fixations. Hernia 16(2):153–162CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Life Memorial HospitalBucharestRomania

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