Abstract
Background
The repair of ventral hernias by intra-peritoneal patch (IPOM) involves a risk of pain due to stapling as well as intestinal adhesions. Extraperitoneal placement of the patch without fixation can prevent these drawbacks. Techniques of endoscopic preperitoneal repair were previously described by others. The aim of this article is to describe our technique and to evaluate the feasibility and short-term results.
Methods
The totally endoscopic technique consists of dividing the median aponeurotic structures, while preserving the proper linea alba, to create a unique retro-muscular space, in which the patch is deployed without any fixation. Hundred twelve consecutive patients were operated on for ventral hernias (82 umbilical, 20 epigastric, 10 combined). Perioperative data including duration of operation, technical problems, conversions and complications, as well as postoperative pain, time to resume daily activities and time off work were prospectively assessed.
Results
98 (87.5%) patients were operated in ambulatory surgery, and 14 (12.5%) in overnight stay. The mean sizes of the hernia and the patch were 9 (1–50) cm2 and 225 (50–500) cm2, respectively. The mean operation duration was 75 (30–270) min. The peritoneum was opened in 43 (38.4%) cases and closed by suture in 41 instances. There were 5 (4.5%) conversions to IPOM and 4 (3.6%) complications (1 seroma, 1 urine retention, 1 transitory ileus, and 1 intestinal obstruction) which were reoperated. The mean VAS value of postoperative pain was 2.45 (0–8), pain was scored 0 by 17 (15%) patients. The mean times to resume daily activity and work were 4 (1–15) days and 11.5 (1–30) days, respectively.
Conclusion
Our results suggest that VTEP is safely feasible by surgeons skilled in laparoscopy, and might contribute to minimize pain, though this must be established by comparative studies.
Similar content being viewed by others
References
Castro PM, Rabelato JT, Monteiro GG, del Guerra GC, Mazzurana M, Alvarez GA (2014) Laparoscopy versus laparotomy in the repair of ventral hernias: systematic review and meta-analysis. Arq Gastroenterol 51:205–211
Mathes T, Walgenbach M, Siegel R (2016) Suture versus mesh repair in primary and incisional ventral hernias: a systematic review and meta-analysis. World J Surg 40:826–835
Holihan JL, Hannon C, Goodenough C, Flores-Gonzales JR, Itani KM, Olavarria O, Mo J, Ko TC, Kao LS, Liang MK (2017) Ventral hernia repair: a meta-analysis of randomized controlled trials. Surg Infect (Larchmt) 18:647–658
Kaufmann R, Halm JA, Eker HH, Klitsie PJ, Nieuwenhuizen J, Van Geldere D, Simons MP, Van der Horst E, van’t Riet M, van der Holt B, Kleirensinck GJ, Jeekel J, Lange JF (2018) Mesh versus suture repair of umbilical hernia in adults: a randomised, double-blind, controlled, multicentre trial. Lancet 391:860–869
Liot E, Bréguet R, Piguet V, Ris F, Volonté F, Morel P (2017) Evaluation of port site hernias, chronic pain and recurrence rates after laparoscopic ventral hernia repair: a monocentric long-term study. Hernia 21:917–923
Reynvoet E, Deschepper E, Rogiers X, Troisi R, Berrevoet F (2014) Laparoscopic ventral hernia repair: is there an optimal mesh fixation technique? A systematic review. Langenbecks Arch Surg 399:55–63
Muysoms FE, Bontinck J, Pletinckx P (2011) Complications of mesh devices for intraperitoneal umbilical hernia repair: a word of caution. Hernia 15:463–468
Tsapralis D, Vasiliades G, Zaxou Z, Delimpaltadaki TH, Margetousakis TH, Papadokis H, Machairas A, Misiakos EP (2018) Bowel obstruction secondary to migration of a Ventralex mesh: report of a rare complication. Hernia 22:711–714
Sharma A, Chowbey P, Kantharia NS, Baijal M, Soni V, Khullar R (2018) Previously implanted intra-peritoneal mesh increases morbidity during re-laparoscopy: a retrospective, case-matched cohort study. Hernia 22:343–351
Stoppa R (1996). The French operation in a major anterior incisional hernia. In: Skandalakis et al (eds) Modern hernia repair. The Parthenon Publishing Group. New York
Reinpold W, Schroeder M, Berger C, Nehls J, Schroeder A, Hukauf M, Kockerling F, Bittner R (2018) Mini- or less-open sublay operation (MILOS): a new minimally invasive technique for the extraperitoneal mesh repair of incisional hernias. Ann Surg 269:748–755
Schwarz J, Reinpold W, Bittner R (2017) Endoscopic mini/less open sublay technique (EMILOS)-a new technique for ventral hernia repair. Langenbecks Arch Surg 402:173–180
Costa TN, Abdalla RZ, Santo MA, Tavares RRFM, Abdalla BMZ, Ceconnello I (2016) Transabdominal midline reconstruction by minimally invasive surgery: technique and results. Hernia 20:257–265
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
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
Miserez M, Penninckx F (2002) Endoscopic totally preperitoneal ventral hernia repair; surgical technique and short-term results. Surg Endosc 16:1207–1213
Belyansky I, Daes J, Radu VG, Balasubramanian R, Zahiri HR, 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
Belyansky I, Zahiri HR, Sanford Z, Weltz AS, Park A (2018) Early operative outcomes of endoscopic (eTEP access) robotic-assisted retromuscular abdominal wall hernia repair. Hernia 22:837–847
Daes J (2012) The enhanced view–totally extraperitoneal technique for repair of inguinal hernia. Surg Endosc 26:1187–1189
Tandon A, Pathak S, Lyons NJ, Nunes QM, Daniels IR, Smart NJ (2016) Meta-analysis of closure of the fascial defect during laparoscopic incisional and ventral hernia repair. Br J Surg 103:1598–1607
Nguyen DH, Nguyen MT, Askenasy EP, Kao LS, Liang MK (2014) Primary fascial closure with laparoscopic ventral hernia repair: systematic review. World J Surg 38:3097–3104
Liang MK, Holihan JL, Itani K, Alawadi ZM, Flores Gonzales JR, Askenazy EP, Ballecer P, Chong HS, Goldblatt MJ, Greenberg JA, Keith JN, Martindale RG, Orenstein S, Richmond B, Roth JS, Szotek P, Towfigh S, Tsuda S, Vaziri K, Berger DH (2017) Ventral hernia management: expert consensus guided by systematic review. Ann Surg 265:80–89
Earle D, Roth JS, Saber A, Haggerty S, Bradley JF III, Fanelli R, Price R, Richardson WS, Stefanidis D, Sages Guidelines Committee (2016) SAGES guidelines for laparoscopic ventral hernia repair. SAGES Guidelines Committee. Surg Endosc 30:3163–3183
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
Li B, Qin C, Bittner R (2018) Totally endoscopic sublay (TES) repair for midline ventral hernia: surgical technique and preliminary results. Surg Endosc. https://doi.org/10.1007/s00464-018-6568-3
Hauters P, Desmet J, Gherardi D, Dewaele S, Poilvache H, Malvaux P (2017) Assessment of predictive factors for recurrence in laparoscopic ventral hernia repair using a bridging technique. Surg Endosc 31:3656–3663
Funding
No funding was received for this work.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Drs P N, J-P C, C L, H J, S G and E P have no conflict 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.
Rights and permissions
About this article
Cite this article
Ngo, P., Cossa, JP., Largenton, C. et al. Ventral hernia repair by totally extraperitoneal approach (VTEP): technique description and feasibility study. Surg Endosc 35, 1370–1377 (2021). https://doi.org/10.1007/s00464-020-07519-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-020-07519-2