Asian Journal of Research in Surgery

eTEP RS Approach for Ventral Hernia - A Short Term Observational Case Series of Our Initial Experience

Anushtup De *

Department of General, Minimal Access and Bariatric Surgery, Sarvodaya Hospital and Research Centre, Faridabad, India.

Jaspreet Singh Bajwa

Department of General, Minimal Access and Bariatric Surgery, Sarvodaya Hospital and Research Centre, Faridabad, India.

Chandraketu Solanki

Department of General, Minimal Access and Bariatric Surgery, Sarvodaya Hospital and Research Centre, Faridabad, India.

Rishabh Jain

Department of General, Minimal Access and Bariatric Surgery, Sarvodaya Hospital and Research Centre, Faridabad, India.

*Author to whom correspondence should be addressed.

---

Abstract

Background: There has been a significant increase in ventral hernia surgeries over the last few decades. The operative modalities have changed from open surgery to a wide variety of laparoscopic surgery procedures. Our objective of this study is to present the early clinical results of the procedure, its feasibility and key technical aspects.

Methods: This is a prospective short term 6 months analysis of 15 patients in our hospital who underwent eTEP RS surgery for small to medium size ventral hernias between December 2021 and December 2022. We performed an observational study of the feasibility and clinical outcome of the procedure and analysis of the data in terms of operative details, intraoperative and postoperative complications.

Results: Out of 15 patient, 1 patient required conversion to Open Rives Stoppa procedure and was excluded from the study. 14 patients underwent eTEP RS procedure. One patient required additional Transversus Abdominis Release (TAR) procedure for tension free posterior wall closure. The mean duration was 187.5 min and mean postoperative stay was 2.07 days. The mean defect size was 15.28 cm² and average mesh size 359.64 cm². At 6 months follow up, there was no recurrence on clinical examination. However 2 patients had seroma which was managed conservatively.

Conclusion: eTEP RS Procedure is a safe and effective procedure for ventral hernia repair. However surgeons need to have a reasonable skill and expertise in minimally invasive surgery with an understanding of anterior abdominal wall anatomy. Proper case selection in the initial few patients is important.

Keywords: Ventral hernia, eTEP RS procedure, minimally invasive surgery

---

---

---

References

Rives J, Lardennois B, Pire JC, Hibon J. Large incisional hernias. The importance of fail abdomen and of subsequent respiratory disorders. Chirurgie. 1973;99: 547–563.

Stoppa RE. The treatment of complicated groin and incisional hernias. World J Surg. 1989;13:545–554.

Rives J, Pire JC, Flament JB, Palot JP, Body C. Treatment of large eventrations. New therapeutic indications apropos of 322 cases, Chirurgie. 1985;111(3):215–225.

LeBlanc KA, Booth WV. Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: Preliminary findings. Surg Laparosc Endosc. 1993;3(39–41):8258069

Belyansky I, Daes J, Radu VG, Balasubramanian R, Reza Zahiri H, Weltz AS, et al. A novel approach using the enhanced – view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair. Surg Endosc. 2018;32(3):1525–1532. DOI: 10.1007/s00464-017-5840-2

Radu VG. Retromuscular Approach in Ventral Hernia Repair-Endoscopic Rives-Stoppa Procedure. Chirurgia. 2019 Jan 1;114:109-14.

Daes J. The enhanced view–totally extraperitoneal technique for repair of inguinal hernia. Surgical Endoscopy. 2012 Apr;26(4):1187-9.

Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ. Transversus abdominis muscle release: A novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg. 2012;204:709–716.

Baig SJ, Priya P. Extended totally extraperitoneal repair (eTEP) for ventral hernias: Short-term results from a single centre. J Min Access Surg. 2019;15:198-203.

Radu VG, Lica M. The endoscopic retromuscular repair of ventral hernia: the eTEP technique and early results. Hernia. 2019;23(5):945–955.

Nguyen SQ, Divino CM, Buch KE, Schnur J, Weber KJ, Katz LB, Reiner MA, Aldoroty RA, Herron DM. Postoperative pain after laparoscopic ventral hernia repair: a prospective comparison of sutures versus tacks. JSLS: Journal of the Society of Laparoendoscopic Surgeons. 2008 Apr; 12(2):113.

Cobb WS, Kercher KW, Heniford BT. Laparoscopic repair of incisional hernias. Surgical Clinics. 2005 Feb 1;85(1):91-103.

Mishra A, Jabbal H S, Nar A S, Mangla R. Analysis of 'enhanced-view totally extra-peritoneal' (eTEP) approach for ventral hernia: Early results. J Minim Access Surg; 2022 Oct 6. DOI: 10.4103/jmas.jmas_129_22

Sharma BB, Singhal S, Sharma AK, Vishnoi D. Endoscopic eTEP-RS for small ventral hernia: Initial experience at MGH hospital. European Journal of Molecular & Clinical Medicine. Summer 2022;9(7).