E-TEP in Ventral and Incisional Hernia Repair – Our Experiences

Background: Rives-Stoppa repair has become the standard for repairing ventral and incisional hernias. The endoscopic retromuscular approach has the same benefits and offers the advantages of minimal invasive surgery. Method: The technique is based on the retromuscular approach to the linea semilunaris (longitudinal technique) or the linea semicircularis (transverse technique). The incision is made on the anterior rectus sheath, and the trocar is placed below the muscle. A retromuscular space is created and the neck of the hernia sac can be reached. Upon release of the hernia, the sheath of the opposite rectus muscle opens up entirely up to the semilunar line, allowing the creation of enough space for placing the mesh. The mesh can be fixed using transcutaneous sutures, glue or be non-fixed. It is not always necessary to close the defect. Results: Between 2003 and 2017 we performed 108 operations. We had 35 umbilical, 17 epigastric, one Spigelian and 55 incisional hernias. There were no intraoperative complications with ventral hernias, and one bowel injury in the incisional hernia group. There were five conversions and four recurrences. All of them were caused by a small mesh, after insufficient dissection. There were no infections. Conclusion: Unlike LVRH, e-TEP will probably achieve the results and benefits of the retromuscular open technique.