Ventral ETEP, results of our experience after exceeding 150 cases. Operative outcomes and learning curve.

Abstract

Purpose: Laparoscopic repair of ventral hernias has evolved significantly. The enhanced-view totally extraperitoneal (eTEP) technique, which places the mesh in a retromuscular plane, has emerged as an alternative to traditional open and laparoscopic approaches, particularly in patients with associated diastasis recti. This study evaluates the efficacy and safety of eTEP in patients with ventral hernias and diastasis recti.

Methods: A retrospective study was conducted on patients who underwent eTEP for ventral hernia repair at a university hospital between January 2019 and September 2024. Demographic data, hernia characteristics, operative time, postoperative complications, and recurrence were collected. Furthermore, the learning curve for ventral hernia repairs was assessed using the CUSUM statistical method.

Results: 163 patients underwent eTEP for ventral hernias. The majority were male (50.3%) with a mean age of 53.5 years. Primary hernias were most common (77.3%), and diastasis recti was present in 82.8% of cases. The mean operative time was 137.2 min. Conversions to open surgery represented 2.5%. The most common postoperative complications were seromas (6.7%) and wound infections (3.1%). The long-term recurrence rate was 0.6%. The average follow-up duration was 15.3 ± 21.3 months. The learning curve for eTEP in umbilical hernia repair was established after performing 14 cases.

Conclusions: eTEP has proven to be a safe and effective technique for ventral hernias, with a seroma incidence of 6.7%, a recurrence rate of 0.6%, and a learning curve of 14 cases.