Enhanced-view totally extraperitoneal repair in a patient with incisional hernia after robot-assisted laparoscopic radical prostatectomy: a case report

Abstract

Background Although laparoscopic incisional hernia repair, especially laparoscopic intraperitoneal onlay mesh, is a widely used technique, it can cause serious complications, including mesh erosion, adhesive bowel obstruction, and chronic pain. The enhanced-view totally extraperitoneal (eTEP) technique has been reported to prevent such complications by placing the mesh in the retrorectus space. Here, we report the case of a patient with post-robot-assisted laparoscopic radical prostatectomy (RARP) incisional hernia repaired using the eTEP technique. Case presentation A 67-year-old man, who underwent RARP for prostate cancer 4 years ago developed an incisional hernia. Abdominal computed tomography showed the presence of an epigastric incisional hernia measuring 4 cm long and 3.7 cm wide. We performed an eTEP repair. We closed the hernia defect using a 0 barbed suture and placed a self-gripping mesh measuring 20 cm long and 15 cm wide in the developed retrorectus space with no fixation. There were no postoperative complications, and the patient was discharged on postoperative day 2. Conclusions eTEP repair is considered an extremely effective surgical treatment option for incisional hernias because of its few resulting postoperative mesh-and-tacker-related complications.

Outcomes after ventral hernia repair using the extended totally extraperitoneal approach: Initial experience from the Philippines

“…Other reported SSOs include (1) dehiscence of the plicated linea alba/anterior fascia resulting in upper abdominal bulging and (2) disruption of the PRS/peritoneum resulting in bowel herniation and/or obstruction. 8,17,25,26 The first randomized controlled trial (RCT) in 2022 comparing eTEP (30) and IPOM (30) for ventral hernia showed that the former was more cost-effective and associated with lower seroma rates, postoperative pain scores, and earlier return to activity. 27 In 2023, another RCT (29 eTEP vs. 27 IPOM) also showed lower postoperative pain scores with eTEP but was associated with higher surgeons' workload.…”

“…Treating hernia recurrences after a retromuscular dissection and/or TAR is technically challenging and should be performed in experienced/high‐volume centers. Other reported SSOs include (1) dehiscence of the plicated linea alba/anterior fascia resulting in upper abdominal bulging and (2) disruption of the PRS/peritoneum resulting in bowel herniation and/or obstruction 8,17,25,26 …”

Enhanced-view totally extraperitoneal repair in a morbidly obese patient with epigastric and umbilical hernias in combination with rectus diastasis: A case report

“…2 shows a schema of the endoscopic port placement in this case. The eTEP repair was performed as previously described [ 9 ]. The preperitoneal and bilateral retrorectus spaces were created from the cranial to the caudal direction by incising the bilateral posterior rectus sheaths.…”