Implementing laparoscopic enhanced-view totally extraperitoneal technique for ventral hernias in Korea: Real world feasibility and surgical outcomes.

Introduction: The enhanced-view totally extraperitoneal (eTEP) technique has emerged as a promising minimally invasive option for ventral hernia repair. Despite the global uptake, data from East Asian populations remain limited. This study presents the first Korean experience with laparoscopic eTEP, underscoring its real-world feasibility, safety and technical versatility.

Patients and methods: We retrospectively analysed 39 patients who underwent eTEP repair for primary or incisional ventral hernias at a Korean tertiary centre between October 2018 and December 2023. Port placement strategies - conventional multi-port, reduced-port, single-port and hybrid approaches - were tailored to hernia characteristics. Patient demographics, operative details and short-term outcomes were evaluated.

Results: Of the 39 patients, 32 (82.1%) were initially approached laparoscopically and seven (17.9%) underwent preplanned hybrid repair. Transversus abdominis release was conducted in seven patients. The mean operative time was 186 ± 35.9 min, and the mean hospital stay was 7.05 ± 4.10 days. The overall postoperative complication rate was 20.4%, including a 5.1% recurrence rate and 10.2% wound complications. No surgical site infections were observed. Five conversions to open surgery occurred in the early learning phase. Diverse port placement techniques improve access and ergonomics, particularly in complex cases.

Conclusion: Our initial experience in Korea supports the feasibility and safety of laparoscopic eTEP for ventral hernia repair. The technique's adaptability to various hernia types and compatibility with the Korean healthcare environment indicate a strong potential for broader adoption. These findings may help guide implementation in similar surgical settings.