Extended-view totally extraperitoneal approach for midline primary and incisional ventral hernia repair: Initial results and experience from a single institution in Vietnam

Abstract

Objective

Abdominal wall hernias, particularly midline primary and incisional types, represent a common and challenging surgical condition. The extended-view totally extraperitoneal (e-TEP) technique has recently been adapted for ventral hernia repair, offering potential advantages over other approaches. This study aimed to evaluate the initial outcomes and institutional experience of the e-TEP technique for midline primary and incisional ventral hernia repair at a tertiary center in Vietnam.

Methods

This prospective descriptive study was conducted on 65 patients with midline primary or incisional ventral hernias who underwent e-TEP repair between June 2022 and August 2024. All procedures were performed by two experienced surgeons at the Department of General Surgery, Can Tho General Hospital, Vietnam. Follow-up continued until February 2025. Data were collected and analyzed on demographics, clinical characteristics, surgical details, postoperative outcomes, and recurrence.

Results

A total of 65 patients, with a mean age of 57.9 ± 12.6 years, a mean BMI of 25.0 ± 3.3 kg/m², and 47 (72.3%) female, were included. The types of hernias included primary hernias in 63.1% (41 patients) and incisional hernias in 36.9% (24 patients). Among the incisional hernias, 3 cases were recurrences. The median defect area was 9 cm² (range, 1–50 cm²). A 15 cm × 15 cm mesh was used in nearly all cases (98.5%). The mean operating time was 131.9 ± 51.8 min, with no conversions to open repair or other procedures, and no intraoperative complications were observed. Nine patients (13%) experienced postoperative complications, with seroma being the most common (5 cases). Two patients sustained intestinal injuries that required reoperation, one developed a wound infection and one reported postoperative skin paresthesia. The mean visual analogue scale pain scores at postoperative 24 hours, 48 hours, and at discharge were 4.3 ± 1.3, 3.0 ± 1.5, and 1.0 ± 0.4, respectively. The mean postoperative hospital stay was 4.52 ± 2.24 d. Only one case of recurrence (1.5%) was observed, and no patient reported chronic pain during the mean follow-up period of 14.5 ± 7.6 m.

Conclusion

The e-TEP technique for midline primary and incisional ventral hernia repair is a feasible and safe option when performed by experienced surgeons. It offers a low rate of complications, short hospital stay, and minimal recurrence rates. This technique can be considered a viable alternative for the management of midline ventral hernias, with promising short-term outcomes.