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

Abstract

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

Endoscopic Totally Extraperitoneal Repair of Parastomal Hernia: A Case Report

“…However, there is a risk of intestinal adhesion or fistula, and it can be life-threatening (19). TEP technique is already used in laparoscopic repair of many types of hernia, with good results (11,(20)(21)(22). We successfully separated the peritoneum by TEP endoscopy and repaired the parastomal hernia using synthetic mesh (without anti-adhesion coating).…”

“…There is no connection between these spaces because of their different anatomic levels. In order to connect all of the abdominal spaces, three major partitions and the umbilical area must be penetrated (11). The partitions are as follows: (A) between the lateral edge of the posterior sheath of the rectus abdominis and transverse abdominal muscle; (B) between the medial border of the posterior sheath of the rectus abdominis; and (C) between the transverse fascia of the abdomen extending downward and thickening at the outer edge of the arcuate line.…”

“…Extraperitoneal mesh placement by laparoscopy can improve the surgical results and achieve a better clinical outcome while reducing the overall cost of treatment. The totally endoscopic sublay (TES) technique has been previously described (11) and extraperitoneal/sublay parastomal hernia repair has been explored in open, laparoscopic, endoscopic, and robotic surgeries (12)(13)(14)(15)(16)(17). Here we present a case of a 74-year-old patient with parastomal hernia and a history of open radical resection treated with a totally extraperitoneal (TEP) endoscopic approach, with a good clinical outcome.…”

The endoscopic‐assisted or endoscopic mini‐ or less‐open preperitoneal (E/MILOP) approach for primary and incisional ventral hernia repair

“…Cephalic to the arcuate line, where the posterior sheath is intact, the sublay space consists of the retromuscular layer, between the rectus abdominis and the posterior rectus sheath, and the preperitoneal layer, between the posterior sheath and the peritoneum; however, caudal to the arcuate line, where the posterior sheath is missing, the sublay space is a sole layer posterior to the rectus abdominis and anterior to the peritoneum. Recently, Li et al have described an endoscopic totally extraperitoneal approach (TEA) for primary ventral hernia repair, as well as an endoscopic totally preperitoneal approach for midline ventral hernia repair 4,5 . Dissection of the preperitoneal space can, if successfully done, provide sufficient space for mesh insertion without violating the rectus sheath, and therefore, the preperitoneal approach should be regarded as a separate approach from the so‐called sublay approach in general.…”

Postoperative Pain After Robot-Assisted Laparoscopic Ventral Hernia Repair

“…Leaving a mesh in the abdominal cavity, as with the IPOM technique, carries the risk of interaction with the organs of the abdominal cavity (1). Other approaches have been developed to place the mesh outside the abdominal cavity such as endoscopic Mini-or Less-Open Sublay repair (eMILOS), endoscopic Totally Extraperitoneal Approach (TEA), TransAbdominal PrePeritoneal repair (TAPP), and enhanced-view totally extraperitoneal repair (eTEP) (2)(3)(4). These approaches are technically more complicated, but postoperative pain may be less since tension in the abdominal wall along the hernia defect is lower.…”