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Application of the novel enhanced transabdominal preperitoneal (ETAP) technique for laparoscopic suprapubic incisional hernia repair

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Abstract

Suprapubic incisional hernia is a special type of incisional hernia, the optimal choice of surgery for which remains controversial. Inspired by advantages of laparoscopic incisional hernia repair and inguinal hernia repair, we developed a novel laparoscopic surgery procedure for suprapubic incisional hernia repair: the enhanced transabdominal preperitoneal (ETAP) technique. To create a peritoneal flap, the peritoneum was dissected from 2 cm above the abdominal wall defect to 2 cm below the pubic arch, then the hernia defect was closed with a full-thickness transabdominal suture. Following the position of mesh to cover the defect with an 5-cm overlap on all sides, the peritoneal flap was closed with continuous suture. In this study, a total of 57 patients with suprapubic incisional hernia underwent laparoscopic ETAP. The mean hernia size was 61.5 cm2, the average mesh size was 173.6 cm2, the mean operating time was 90 min, the mean blood loss was 34 cc, and the average hospital stay was 2.6 days. In the follow-up period, which ranged from 12 to 45 months, the overall incidence of complications was 17.86%. Six patients developed seroma without herniation, six patients suffered from obvious postoperative pain, and four patients experienced urinary retention. All complications resolved without treatment. No recurrence was observed. In conclusion, the laparoscopic ETAP technique contributes to reduced rates of suprapubic incisional hernia repair and mesh-induced complications.

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Author notes

  1. Wei Zheng and Zhonglin Zhu contributed equally to this work.

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Henan Provincial People’s Hospital, Zhengzhou, Henan Province, 450003, People’s Republic of China

    Wei Zheng, Zhonglin Zhu, Chao Zhang & Hui Zhang

Authors
  1. Wei Zheng
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  2. Zhonglin Zhu
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  3. Chao Zhang
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  4. Hui Zhang
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Contributions

H.Z. and C.Z. conceived and designed all experiments and the manuscript. W.Z. and Z.Z. collected and analyzed the data. All authors contributed toward the data analysis, drafting and revising the paper, gave final approval of the version to be published and agree to be accountable for all aspects of the work.

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Correspondence to Hui Zhang.

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Conflict of interest

The authors declare no conflicts of interest in association with the present study.

Ethical approval

The project was approved by the Ethics Committee of Henan provincial people’s Hospital. Written informed consent was obtained from all subjects before enrollment in the study.

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Zheng, W., Zhu, Z., Zhang, C. et al. Application of the novel enhanced transabdominal preperitoneal (ETAP) technique for laparoscopic suprapubic incisional hernia repair. Surg Today 50, 525–530 (2020). https://doi.org/10.1007/s00595-019-01879-6

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  • DOI: https://doi.org/10.1007/s00595-019-01879-6

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