A novel approach using the enhanced-view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair

Belyansky, Igor; Daes, Jorge; Radu, Victor Gheorghe; Balasubramanian, R.; Zahiri, H. Reza; Weltz, Adam S.; Sibia, Udai S.; Park, Adrian; Novitsky, Yuri W.

doi:10.1007/s00464-017-5840-2

Cited by 290 publications

(210 citation statements)

References 24 publications

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“…• Mesh placement outside of abdominal cavity represents a huge advantage, avoiding the contact between the mesh and the viscera (with the all late consecutives complications) and, on the other hand, reducing the cost (quite high cost of dual meshes and fixation devices). • The early results of this procedure were published in Surgical Endoscopy (14) and show the superiority then "traditional" laparoscopic approach (IPOM) regarding pain, recovery, recurrence, cost. • My personal experience is 63 cases in the last 18 months.…”

Section: Results Conclusionmentioning

confidence: 99%

Retromuscular Approach in Ventral Hernia Repair - Endoscopic Rives-Stoppa Procedure

Radu¹

2019

chr

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Introducere: În 1993 Leblanc a adăugat în gama operaţiilor laparoscopice repararea herniilor ventrale. Procedeului i-au fost aduse îmbunătăţiri semnificative ca urmare a unor profunde schimbări de paradigmă privind restaurarea arhitecturii şi funcţionalităţii peretelui abdominal. Plasarea protezei în spaţiul retromuscular-iniţial o provocare în chirurgia laparoscopică, este acum o tehnică bine codificată. Metodă: Abordul TEP cunoscut în cura herniei inghinale, este extins cranial în teaca dreptului abdominal. Traversarea liniei albe spre teaca dreptului abdominal controlateral, rămânând în afara cavităţii peritoneale, permite disecţia retromusculară, reducerea herniei, refacerea liniei albe şi plasarea unei proteze de polipropilenă înapoia drepţilor abdominali. Rezultate: În intervalul iunie 2016-decembrie 2017 am aplicat procedeul la 63 de pacienţi cu hernia ventral primare sau incizionale cu suprafaţa mediană de 60 cm 2 (6-300). Pentru închiderea defectului şi refacerea liniei albe a fost necesar efectuarea TAR la 19 cazuri. Spitalizarea mediană a fost de 1 zi (1-9) iar urmărirea pacienţilor s-a efectuat la 2 luni, 6 luni, 1 an. Până în prezent a fost înregistrat 1 caz cu durere cronică şi nici un caz de recidivă. Concluzie: Combinând avantajele operaţiei Rives-Stoppa cu avantajele operaţiilor minim invazive, abordul endoscopic retromuscular tinde să ocupe un loc primordial în cura herniilor ventrale. Cuvinte cheie: abord endoscopic TEP, repararea herniei ventrale retromosculare

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Section: Results Conclusionmentioning

confidence: 99%

Retromuscular Approach in Ventral Hernia Repair - Endoscopic Rives-Stoppa Procedure

Radu¹

2019

chr

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“…Several novel extraperitoneal techniques have been developed to perform retromuscular repair through minimally invasive methods, including mini/ less open sublay (MILOS) repair [9], followed by modified Fig. 7 Placement of a 15 × 9-cm 2 self-gripping mesh in the extraperitoneal space (a case of umbilical hernia) MILOS surgery with endoscopic assistance (e-MILOS) [10], laparoscopic transabdominal retrorectus repair [11], endoscopic transabdominal midline reconstruction technique facilitated by endoscopic linear stapling [12], completely endoscopic sublay dissection methods including the enhanced-view totally extraperitoneal (eTEP) technique initiated by Belyansky et al [13], and the TES repair technique reported by our team [2].…”

Section: Discussionmentioning

confidence: 99%

“…Undoubtedly, in an epigastric hernia that is extremely close to the xiphoid process, a long distance extraperitoneal dissection from the suprapubic area to the xiphoid area will require a lot of dissection and seems to be unreasonable. In these cases, some surgeons recommend the transabdominal approach to enter the preperitoneal space [6]; however, an e-MILOS or eTEP technique seems to be more appropriate in this scenario than any other techniques [10,13]. For a congenital lumbar hernia that is herniated from the superior lumbar triangle (Grynfeltt hernia), a retroperitoneal endoscopic approach can be utilized to achieve extraperitoneal repair [25].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic totally extraperitoneal approach (TEA) technique for primary ventral hernia repair

Qin

Bittner

2020

Surg Endosc

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Background Up to now the totally extraperitoneal (TEP) technique is limited to the treatment of inguinal hernias. Applying this anatomical repair concept to the treatment of other abdominal wall hernias, we developed an endoscopic totally extraperitoneal approach (TEA) to treat primary midline ventral hernias, including umbilical and epigastric hernias, in which for mesh placement, an anatomical space is developed between the peritoneum and the posterior rectus sheath in the ventral part of the abdominal wall (preperitoneal space). Methods Between September 2017 and December 2019 according to the selection criterions, 28 consecutive primary midline ventral hernias were repaired using TEA. After extensive endoscopic development of the midline extraperitoneal plane, which was started in the suprasymphysic area, and reduction of the hernia sac, the hernia defect was closed and a large mesh was placed in the preperitoneal position to enforce the anterior abdominal wall. Results All operations were successfully performed without conversion to open surgery. The mean operation time was 103.3 min (range 85-145 min). Patient-reported postoperative pain was qualitatively mild with a mean pain visual analogue scale score of 1.9 on postoperative day 1. The average hospital stay was 1.9 days (range 1-3 days). Three patients developed minor complications and were treated with no long-term adverse effects. Readmissions within 30 days or hernia recurrences were not observed with a mean follow-up period of 18 months (range 10-27 months). Conclusion In selected cases, TEA is a safe and feasible minimally invasive alternative in treating primary ventral hernias. This technique preserves the anatomical and physiological structure of the abdominal wall and may significantly reduce trauma and postoperative complications. Additionally, anti-adhesion-coated meshes and fixation tackers are not required, thus being cost-effective. Further studies are necessary to proof the true clinical efficacy in comparison to well-known alternative techniques.Keywords Primary ventral hernia · Umbilical hernia · Epigastric hernia · Endoscopic repair · Totally extraperitoneal approach The totally extraperitoneal (TEP) technique for repair of inguinal hernia was first reported in 1992 by Dulucq [1] and has since been continuously refined and standardized. In fact, it has become one of the gold standard procedures for the treatment of inguinal hernia in adults. The extraperitoneal and Other Interventional Techniques

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“…The main reasons were the great technical di culty of the procedure and the long operative time. However, this situation has changed in the last 2 years, as many articles about this emerging technique from different countries have been published (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24).…”

Section: Introductionmentioning

confidence: 99%

A Preliminary Multicenter Evaluation of Endoscopic Sublay Repair for Ventral Hernia From China

Tang

Jiang

et al. 2020

Preprint

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Background For ventral hernia, endoscopic sublay repair (ESR) may overcome the disadvantages of open sublay and laparoscopic intraperitoneal onlay mesh repair. This retrospective study presents the preliminary multicenter results of ESR from China. The feasibility, safety, and effectiveness of ESR were evaluated; its surgical points and indications were summarized. Methods The study reviewed 156 ventral hernia patients planned to perform with ESR in ten hospitals between March 2016 and July 2019. Patient demographics, hernia characteristics, operative variables, and surgical results were recorded and analyzed. Results ESR was performed successfully in 153 patients, 135 with totally extraperitoneal sublay (TES) and 18 with transabdominal sublay (TAS). In 19 patients, TES was performed with the total visceral sac separation (TVS) technique, in which the space separation is carried out along the peritoneum, avoiding damage to the aponeurotic structure. Endoscopic transversus abdominis release (eTAR) was required in 17.0% of patients, and only 18.3% of patients required permanent mesh fixation. The median operative time was 135 min. Most patients had mild pain and resume eating soon after operation. No severe intraoperative complications occurred. Bleeding in the extraperitoneal space occurred in two patients and was stopped by nonsurgical treatment. Seroma and chronic pain were observed in 5.23% and 3.07% of patients. One recurrence occurred after TAS repair for an umbilical hernia. Conclusion ESR is feasible, safe, and effective for treating ventral hernias when surgeons get the relevant surgical skills, such as the technique of “partition breaking,” TVS, and eTAR. Small-to-medium ventral hernias are the major indications.

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A novel approach using the enhanced-view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair

Cited by 290 publications

References 24 publications

Retromuscular Approach in Ventral Hernia Repair - Endoscopic Rives-Stoppa Procedure

Retromuscular Approach in Ventral Hernia Repair - Endoscopic Rives-Stoppa Procedure

Endoscopic totally extraperitoneal approach (TEA) technique for primary ventral hernia repair

A Preliminary Multicenter Evaluation of Endoscopic Sublay Repair for Ventral Hernia From China

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