Lateral incisional ventral hernia: can etep approach enhance the outcomes?

Abstract Objective To present the application of the extended totally extraperitoneal (eTEP) approach in lateral incisional hernias and to analyze the results in our series of cases. Materials and Methods Retrospective comparative multicenter study based on a prospective database conducted at Fundacion Jimenez Diaz University Hospital and La Paz Hospital in Madrid that includes eTEP incisional ventral hernia repairs performed between March 2019 and January 2023. The inclusion criteria were lateral incisional hernias W1 and W2 according to the classification of the European Hernia Society (EHS). Preoperative, intraoperative, and postoperative data were collected. Results In the study period, 159 ventral hernias were intervened by eTEP access and a total of 49 incisional hernias were analyzed. By location, 3 cases were L1, 25 cases were L2, 15 cases were L3, and 6 cases were L4. The median defect size was 48mm (11–126). The median surgical time was 115 minutes (45–237) and transverse muscle release was applied in 36 cases (73.5%). The median length of stay was 1 day (1–7) and 14 (28.6%) patients were intervened on an outpatient basis. Four (8.2%) postoperative complications and 1 (2%) recurrence were evident. The median follow-up was 21 months (3–46). Conclusions The treatment of lateral incisional hernias by eTEP approach is feasible and abdominal transverse muscle release may have to be applied in many cases. It presents excellent results in our series in terms of complication rate, recurrence rate, hospital stay, and proportion of outpatient treatment.