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

Purpose 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). Method 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. Results 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. Conclusion 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.