Risks of re-operation in ventral hernias in non-American populations and recurrence have been studied extensively. However, data on early risk factors for reoperation in North America are still lacking. The most recent NSQIP study, analyzing risk factors for reoperation of ventral hernias was extracted from 2005-2008 data. Since then, there have been major advances in ventral hernia repair techniques. Here, we identify risk factors and indications for re-operation within 30 days.

NSQIP ACS data from 2020-2022 were used in our analysis. Additional procedures that posed significant morbidity and mortality were excluded. Risk factors were analyzed with univariate and multivariable models to determine association with re-operation within 30 days. ICD10 codes for re-operation were also analyzed.

Of 56,260 patients, 2.38 % returned to the OR within 30 days. Higher ASA, male gender, surgical site infection (SSI), smoking, ascites, age group > 70, dialysis patients, open surgeries and dehiscence were significantly associated with re-operation whereas outpatient surgery was protective in univariate and multivariable models (p < 0.01). The most common indications for re-operation were surgical site occurrence (SSO) and recurrence of hernia. Mortality was significantly higher in the reoperation group, 3.29 %, compared to those patients that did not require early reoperation (0.36 %, p < 0.01).

Mortality and early reoperation rates have decreased in the past decade in the U.S, which could be attributed to advancement in ventral hernia repair techniques. Our analysis of risk factors for reoperation supports findings in the broader literature. This study also suggests that SSO and recurrence of hernia are leading diagnoses for early reoperation.

Currently, Brazil does not have a registry of abdominal wall hernia surgeries. In this paper we describe the creation of HERNIACLINIC-QoL, that aims to fill this gap, and its preliminary results.

A RedCap form was developed to collect data on patients and surgeries for abdominal hernia repair in a private practice hospital. Data input errors were checked every 30 days, and a preliminary analysis of the database as a whole was carried out in 2024.

We registered 554 patients (201 ventral, 227 inguinal and 103 for both hernias). The form needed corrections in the fields: preoperative data, hernia sizes and classifications, rectum diastasis and anesthesia type, ensuring completeness of data and simplifying the creation of statistical reports.

HERNIACLINIC-QoL may become a valuable tool for hernia care and research, as its use is expanded to include more surgeons and more patients.

Protocol Register at Brazilian Registry of Clinical Trials (ReBEC), ID: RBR-5vmhdfs https://ensaiosclinicos.gov.br/rg/RBR-5vmhdfs.

The laparoscopic intraperitoneal onlay mesh (IPOM) technique has been widely used for ventral hernia repair; however, concerns regarding mesh-related complications have led to the development of alternative approaches. The enhanced-view totally extraperitoneal (eTEP) technique has emerged as a promising alternative, offering improved anatomical restoration and reduced postoperative morbidity. This study compares the clinical outcomes of eTEP and IPOM for ventral hernia repair.

A retrospective cohort study was conducted at a tertiary referral centre in Thailand. Patients who underwent laparoscopic ventral hernia repair using either eTEP or IPOM between January 2016 and December 2021 were included. Demographic data, hernia characteristics, perioperative variables, and postoperative outcomes were analysed. Statistical comparisons were performed using parametric and non-parametric tests, with a significance threshold of p < 0.05.

A total of 70 patients were included, with 32 undergoing eTEP and 38 undergoing IPOM. Both groups were comparable in baseline characteristics, with most cases classified as incisional hernias. The mean operative time was significantly longer in the eTEP group (360 vs. 240 min, p < 0.001). Subgroup analysis showed significantly lower postoperative pain scores at 12 and 24 h in the eTEP-RS and eTEP-TAR groups compared to the IPOM group (p < 0.001). The mean VAS scores at 12 h were 4 (eTEP-RS), 3 (eTEP-TAR), and 7.5 (IPOM), while at 24 h, they decreased to 2 (eTEP-RS), 2 (eTEP-TAR), and 4 (IPOM). Complication rates were comparable between groups; however, minor bowel injury was reported in some IPOM cases. The one-year recurrence rate was 3.1% for eTEP and 7.9% for IPOM (p = 0.620), increasing to 6.2% and 15.8% at 2 years, respectively (p = 0.275).

Laparoscopic eTEP is a safe and effective alternative to IPOM for medium to large ventral hernias, demonstrating lower postoperative pain and recurrence rates. However, its technical complexity and longer operative time highlight the importance of careful patient selection and surgical expertise. Further prospective studies with larger sample sizes are needed to validate these findings and optimise clinical outcomes.

Postpartum rectus abdominis diastasis (PP-RAD) is a condition that may cause abdominal wall insufficiency, affecting daily life. When conservative treatments are unsuccessful, surgical intervention may be necessary. This study aimed to assess the safety and effectiveness of minimal incision repair of rectus abdominis diastasis (MIRRAD) as day-case surgery in women with PP-RAD.

This study included 33 female patients aged 20-50 years with PP-RAD and an inter-rectus distance (IRD) of ≥ 3 cm. All patients had previously undergone conservative treatment without satisfactory outcomes. Each patient received the MIRRAD procedure as day-case surgery apart from one who stayed overnight due to nausea. Follow-up evaluations were conducted at 4 h, 1 week, 1 month, and 1 year after surgery.

The average inter-rectus distance (IRD) was 4.4 cm, with a mean diastasis length of 15 cm. Of the 33 patients included, 2 did not attend the 1 year follow-up leaving 31 for final analysis. Of these, 30 had one or more concomitant hernias. The mean operation time was 67 min. At the 1 year follow-up, 87% of patients were satisfied with the results, and 90% said they would undergo the procedure again if necessary. No surgical site infection was reported, and recovery was generally smooth. Thirty of the 31 patients were discharged within 4 to 6 h after surgery, while one patient stayed overnight.

MIRRAD appears to be a safe and effective surgical option for PP-RAD, particularly in cases without significant excess skin. Further studies with larger populations and longer follow-up are needed to confirm these findings and establish standard patient selection criteria.

Background: Ventral hernias are common abdominal wall defects requiring surgical repair to prevent complications. This study compared two techniques: minimally invasive enhanced-view totally extraperitoneal (eTEP) approach and the open sublay (OS) method, historically regarded as the gold standard. Methods: A retrospective single-center study was conducted between July 2019 and March 2023 at the Department for General and Visceral Surgery, Klinikum Oldenburg. All patients who underwent either eTEP or OS for ventral hernia repair were included. Patient demographics and perioperative data were collected and compared. Results: A total of 139 patients were analyzed, with 92 undergoing eTEP repair and 47 undergoing OS. Both groups were comparable in demographic and clinical characteristics. Significant differences were found in defect size (median 6 cm2 for eTEP vs. 16 cm2 for OS, p < 0.028) and mesh size (median 450 cm2 for eTEP vs. 150 cm2 for OS p < 0.001). Operative time (p = 0.119) and postoperative pain levels over 3 days showed no significant differences (VAS Day1 p = 0.884; VAS Day3 p = 0.636). Intraoperative complications were 2.17% for eTEP and 6.38% for OS (p = 0.207). Postoperative complications (6.52% vs. 21.28%, p = 0.009) and hospital stay (median 3 days vs. 5 days, p < 0.001) were significantly lower in the eTEP group. Conclusions: eTEP is a safe, effective procedure and appears to offer more advantages than OS for ventral hernia repair. It is associated with a significantly lower complication rate, as well as shorter hospital stay.

For ventral/incisional hernias between 1 and 4 cm, there is still controversy regarding open or laparoscopic mesh repairs. The study evaluated via a propensity-score adjusted analysis, the differences in outcomes between a laparoscopic and open ventral hernia mesh repair.

A single institution retrospective cohort study was performed. All patients with a ventral or incisional hernia between 1 and ≤ 4 cm, with a mesh repair, were reviewed. A propensity-score adjusted analysis was performed to account for baseline differences. Subgroup analyses were also performed. Outcome measures included recurrence, chronic pain, complications, postoperative adhesive occurrences, length of stay and operative duration.

Over a 6-year period, 194 patients (91 laparoscopic; 103 open) were included. Mean follow-up duration and defect size were 8.0 months and 2.6 cm, respectively. Baseline differences in the univariate analysis between groups were adjusted for via propensity scoring. In the propensity-score adjusted analysis, a laparoscopic mesh repair was significantly associated with a lower likelihood of postoperative adhesive occurrences, with no differences in recurrence, chronic pain, complications, length of stay and operative duration. This association remained for hernia defects down to ≤ 3 cm. There were no significant differences between the laparoscopic and open groups when stratified for hernia defects of 1-2 cm. For the subgroup analysis, in contrast to an intraperitoneal on-lay mesh placement, open on-lay mesh placement was associated with a higher likelihood of postoperative adhesive occurrences.

For patients with small-sized ventral/incisional hernias between 1 and 4 cm, laparoscopic mesh repairs may be associated with reduced postoperative adhesive occurrences, with no difference in other outcomes.

Minimally invasive techniques are widely used to treat abdominal wall defects. This study describes a cranial approach for performing the total preperitoneal/pretransversalis enhanced-view totally extraperitoneal (PeTEP) technique and presents early outcomes for treating primary ventral hernias (PVH), midline trocar site incisional hernias (IHs), both associated with rectus diastasis, as well as lateral IHs.

An observational study was conducted from October 2023 to September 2024, identifying cases where the cranial PeTEP technique was employed, using data from a multicentric prospectively maintained database. The cranial approach involved dissection of the preperitoneal fatty rhomboid, extending the dissection across the preperitoneal and transversalis fascial plane to the semilunar lines laterally and the pubis caudally. For lateral defects, the dissection extended beyond the ipsilateral semilunar line, surpassing the lateral edge of the defect.

Twenty-four patients underwent elective endoscopic hernia repair: 62.5% PVH, 29.2% midline IH, and 8.3% lateral IH. The mean defect area was 6.32 ± 6.13 cm2, and the average mesh size was 497.21.41 ± 202.71 cm2. The surgical site occurrences rate was 8.3%, with no surgical site infections or recurrences at a mean follow-up of 5.3 months.

The cranial PeTEP technique was a safe, effective, and reproducible method for repairing PVH and small-medium IHs associated with rectus diastasis in a selected cohort of patients. It facilitated large preperitoneal mesh placement without entering the retromuscular plane and avoided posterior component separation in lateral defects. Larger studies with extended follow-up are needed to confirm these promising results.

The extended totally extraperitoneal technique (eTEP) is a novel approach for ventral hernia repair. This technique has been recently advanced using robotics (r-eTEP). The aim of this study is to perform a comprehensive analysis of the initial results of r-eTEP and to evaluate the safety and efficacy of this technique compared to the eTEP technique.

This is a monocentric retrospective study of patients with ventral hernias who underwent surgery via eTEP or r-eTEP in our department between 2019 and 2023. Propensity score matching was applied to compare the groups. Preoperative patient and hernia characteristics, intraoperative findings, and postoperative outcomes were subsequently analysed.

Patient demographics were comparable between the groups. The r-eTEP group had a significantly greater proportion of M3 hernias (p = 0.006), M4 hernias (p = 0.020), incisional hernias (p = 0.002), and hernias with rectus diastasis (p < 0.001). The r-eTEP group had a significantly larger hernia defect (p = 0.003) and larger mesh size (p = 0.015). The r-eTEP group had a shorter hospital stay (p < 0.001) and shorter operative time, though not statistically significant (p = 0.211). Intraoperative and postoperative complications, as well as postoperative pain, were comparable between the groups.

The findings of the present study show that the r-eTEP technique may offer potential benefits as the overall hospital stay was shorter while intraoperative and postoperative complications were comparable for both techniques.

Despite the high prevalence of ventral hernias worldwide, intraoperative drain placement remains a controversial topic. The benefit in reducing postoperative complications has not yet been clearly demonstrated. This study investigates whether a drain prevents postoperative complications after minimally invasive ventral hernia repair using the extended-totally-extraperitoneal-(eTEP)-technique.

This monocentric, retrospective cohort study included all patients who underwent eTEP between 2019 and 2024. Two comparison groups were formed (54 patients with drain,106 patients without) and analysed for potential differences.

There were no significant sociodemographic or clinical differences between the study groups. The defect size was larger in the drain group (drain: 13 cm2 (64,5) †, no-drain: 6,5 cm2 (21) †, p = 0,025). There were no significant differences regarding frequency of postoperative complications (drain: 13%, no-drain: 8,5%, p = 0,373), surgical site infections (SSI) (drain: 0%, no-Drain: 1,9%, p = 0,550), and surgical site occurrences (SSO) (drain: 13%, no-Drain: 4,7%, p = 0,108). A subgroup analysis showed that robotically operated patients were more frequently provided with drains (rob: 30 (47,6%), lap: 24 (24,7%), p = 0,003), had larger defect sizes (rob: 28 cm2 (72)†, lap: 6 cm2 (9,87)†, p < 0,001), and received Transversus-abdominis-releases (TAR) more often (rob: 14 (22,2%), lap: 5 (5,2%), p = 0,001).

We found no significant differences between patients with and without drains after eTEP regarding the frequency of postoperative complications, SSOs and SSIs. Our findings do not suggest nor refute that wound drains prevent postoperative complications.

Incisional hernia (IH) repair in morbidly obese (MO) patients poses significant challenges due to higher risks of complications and recurrence. Traditional open repairs are linked to increased morbidity, driving interest in minimally invasive techniques. The enhanced view totally extra-peritoneal Rives-Stoppa (eTEP-RS) technique shows promise as a laparoscopic method for IH repair, but data on its efficacy and safety in MO patients are limited. This study aims to evaluate the efficacy, safety, and feasibility of the eTEP-RS approach specifically for IH repair in this high-risk population.

Analysis of a retrospective cohort of consecutive patients undergoing laparoscopic eTEP-RS for IH repair between 2017 and 2022 which included 135 patients, categorized into two groups based on body mass index (BMI): the MO group (BMI > 35 kg/m2) and the control group (BMI ≤ 35 kg/m2). We compared demographics, comorbidities, hernia characteristics, intra-operative data, post-operative outcomes, and hernia recurrence rates.

Patients in the MO group had significantly more type 2 diabetes mellitus (n = 18, 51% vs n = 25, 25%; p = 0.004), hypertension (n = 35, 73% vs n = 75, 53%; p = 0.017), dyslipidemia (n = 29, 60% vs n = 58, 41%; p = 0.021), ASA score 3 (n = 18, 52% vs n = 23, 23%; p = 0.004), a history of previous umbilical hernia repair (n = 13, 27% vs n = 13, 9.2%; p = 0.002), and bariatric surgery (n = 10, 29% vs n = 13, 13%; p = 0.035). There were no differences in intra-operative characteristics, operative times, or intra-operative complications between groups. During a median follow-up period of 1 year (IQR 40-680 days), there were no differences in hernia recurrence (n = 2, 5.7% vs n = 9, 9%; p = 0.07), time to recurrence, or chronic analgesia usage between groups.

The laparoscopic eTEP-RS approach was safe and effective for IH repair in patients with MO, demonstrating comparable post-operative outcomes and recurrence rates to those with a lower BMI in a selected cohort of patients.

Endoscopic onlay repair (ENDOR) approach is gaining traction as a promising technique for the treatment of diastasis recti and associated ventral hernia. However, comprehensive evidence regarding its perioperative and short-term outcomes remains scarce. The objective of this meta-analysis is to provide a comprehensive summary of the existing evidence concerning perioperative and short-term postoperative outcomes.

A systematic literature review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A comprehensive search was conducted in MEDLINE, Embase, and CENTRAL until August 1st, 2024. Articles reporting outcomes of ENDOR in adult population diagnosed with diastasis recti associated or not with primary or incisional ventral hernia were included. Primary outcomes were evaluated based on safety and short-term measures, including intraoperative and short-term postoperative characteristics. A fixed effects model was used for meta-analysis. The methodological quality of the studies was assessed using the Methodological Index for Non-randomized Studies (MINORS) criteria.

A total of 12 studies (480 patients) were identified. Minimally invasive ENDOR resulted in an intraoperative complications and conversion rate of 1.0% [95% CI 0.0-2.0%]. The rate of seroma was 25% [95% CI 12.0-39.0%], the one of surgical site infection was 1% [95% CI 0.0-2.0%] and the rate of hematoma was 2% [95% CI 1.0-3.0%]. After a median follow-up of 16 months (1.8-39), the rate of recurrence was 2% [95% CI 0.0-3.0%].

The minimally invasive ENDOR approach stands out as a safe and effective method for diastasis recti and associated ventral hernia repair in selected patients, exhibiting low rates of intraoperative complications and yielding favorable outcomes. Prospero registry Registration number: CRD42024573235.

Ventral hernia repairs (VHR) are commonly performed surgical procedures in the United States, with over 300,000 cases treated annually. Robotic surgery has gained traction for its safety and efficacy in VHR, particularly with techniques such as myofascial release. However, the extensive dissection involved in these procedures may lead to postoperative complications like seromas and hematomas. This study aims to assess the effectiveness of Arista™, an FDA-approved hemostatic agent, in reducing these complications during robotic-assisted laparoscopic VHR involving mesh placement in the retrorectus space. This single-institution single-blind prospective randomized controlled trial involved 100 patients undergoing elective robotic-assisted laparoscopic VHR at a tertiary referral hernia center. Participants were randomized to receive either 5 g of Arista™ or standard of care intraoperatively, with no hemostat applied in the control group. All patients had drains placed in the retrorectus space. Primary outcomes included drain output on the first postoperative day (POD), total drain output, and duration of drain placement. Secondary outcomes included estimated blood loss (EBL), number of drains used, operative time, and length of stay (LOS). This study was funded by Becton, Dickinson and Company (BD). The mean total drain output was significantly higher in the Arista™ group (592.8 ml) compared to the control group (407.9 ml; p = 0.01), with a 39.6% increase noted. However, no significant difference in drain output on the first postoperative day or drain duration was observed. Secondary outcomes revealed no statistically significant differences in EBL, number of drains, operative time, or LOS between the groups. While the application of Arista™ during robotic-assisted laparoscopic VHR resulted in increased total drain output, it did not significantly affect other postoperative metrics, including LOS and complications. Further research is warranted to explore the potential benefits of Arista™ in specific patient populations and surgical contexts.

The recent availability of robotic platforms has facilitated the adoption of advanced minimally invasive ventral hernia repair. Robotic-assisted ventral hernia repair is an evolving field with many new techniques and acronyms for different accesses and approaches. This paper aims to describe the four currently most used procedures for robotic ventral hernia repair, all of which are MIS sublay repairs; robotic Trans-Abdominal-Preperitoneal (r-TAPP), robotic Trans-Abdominal-Retromuscular-Mesh (r-TARM), robotic Extended-Totally-Extra-Peritoneal (r-E-TEP), and robotic Transversus-Abdominis-Release (RoboTAR). Their descriptions are supported by illustrations. The paper describes trocar placement, practical tips and tricks, and briefly discusses the indications for each procedure. Furthermore, technical details such as the incision of the flap, access to the correct anatomical planes, dissection techniques, handling of the hernia sac, mesh choice and placement, and restoration of the abdominal wall layers are described. In conclusion, robotic ventral hernia repair has gained wide acceptance with promising postoperative results. There are many different techniques and approaches available, and this paper describes the four most commonly performed procedures in a detailed step-by-step fashion.

The development of minimally invasive surgical techniques for ventral hernias has significantly progressed, evolving from IPOM and IPOM + to advancements like eTEP/eTEP-TAR. These newer techniques have demonstrated their effectiveness by delivering excellent postoperative outcomes, despite being introduced less than a decade ago. Recreating traditional procedures, which are considered the "gold standard" in ventral hernia surgery, through minimally invasive methods-such as the Rives-Stoppa repair-could represent the next frontier in abdominal wall surgery. This publication focuses on replicating ventral incisional hernia repair using an extraperitoneal approach, as outlined by Todd Heniford, and taking inspiration from the PeTEP technique for primary ventral hernias, whether associated with diastasis recti or not, as described by Hector Valenzuela.

Enhanced View Totally Extraperitoneal (eTEP) and Intraperitoneal Onlay Mesh (IPOM) are two widely performed laparoscopic approaches for ventral hernia repair. This randomized prospective study aimed to compare these two techniques in terms of various clinical outcomes.

A total of 60 patients presenting with ventral hernias at our hospital between June 2022 and December 2023 were included in the study. All patients were fit for general anesthesia and were randomized into two groups, with 30 patients undergoing eTEP and 30 patients undergoing IPOM.

There were no significant differences in baseline characteristics such as age, sex, or comorbidities between the two groups. The operative time for eTEP was significantly longer, with a mean duration of 211 min compared to 177.5 min for IPOM (p < 0.001). Postoperative pain and analgesic requirements were significantly lower in the eTEP group. Two patients in the eTEP group required conversion to IPOM. No intraoperative complications occurred in either group. Two patients developed seromas on the seventh postoperative day, both of which were managed conservatively. The mean hospital stay was shorter for eTEP (3.43 days) compared to IPOM (6.16 days, p < 0.001). Patients undergoing eTEP had an earlier return to work and reported better abdominal wall quality of life. No recurrences were observed in either group during the six-month follow-up period.

eTEP repair for ventral hernias offers several advantages over the commonly performed IPOM technique, including reduced postoperative pain, shorter hospital stay, and faster recovery. However, the choice of procedure should be guided by the surgeon's expertise and confidence in performing either technique.

Following concerns regarding an intraperitoneal mesh, newer ventral hernia repair (VHR) approaches focus on placing the mesh outside of the peritoneal cavity. The e-TEP technique used the retromuscular space and is suggested to be associated with decreased postoperative pain compared to IPOM +. This study aims to compare the IPOM + with the e-TEP for VHR.

We searched for studies comparing endoscopic IPOM + and e-TEP in PubMed, EMBASE, and Cochrane databases from inception until September 2023. Outcomes were Visual Analog Scale (VAS) after 24 h of surgery and between 7 and 10 days after surgery, operative time, length of stay (LOS), seroma, recurrence, and readmission. RStudio was used for statistical analysis. Heterogeneity was assessed with I2 statistics, with random effect for I2 > 25%.

From 149 records, 7 were included, from which 3 were RCTs, 3 were retrospective studies, and 1 was an observational prospective study. 521 patients were included (47% received e-TEP and 53% received IPOM +). 1 study included only robotic surgeries and 6 studies included only laparoscopy. Mean defect width was 3.62 cm ± 0.9 in the e-TEP group and 3.56 cm ± 0.9 in the IPOM + group. IPOM + had higher VAS after 1 day of surgery (MD - 3.35; 95% CI - 6.44; - 0.27; P = 0.033; I2 = 99%) and between 7 and 10 days after surgery (MD - 3.3; 95% CI - 5.33, - 1.28; P = 0.001; I2 = 99%). e-TEP repair showed with longer operative time (MD 52.89 min; 95% CI 29.74-76.05; P < 0.001; I2 = 92%). No differences were seen regarding LOS, seroma, recurrence, and readmission.

The e-TEP repair is associated with lower short-term postoperative pain after VHR compared to IPOM +, but with longer operative time. More RCTs are required to assess these results with long-term follow-up and determine its role in the armamentarium of the abdominal wall surgeon.

Diastasis recti abdominis (DRA) is an acquired condition defined by a widening of the linea alba exceeding 2 cm and the subsequent separation between the two medial margins of the rectus muscles, accompanied by a laxity of the ventral abdominal muscles, and often by ventral midline hernias. It is a quite common problem in women after pregnancy. In addition to the aesthetic implications resulting from the swelling of the anterior abdominal wall in the case of increased pressure within the abdominal cavity, DRA leads to several physical functional disorders, including muscle weakness, prolapses of the pelvic organs, urinary and fecal incontinence, low back and pelvic pain and sexual dysfunction. The management of diastasis recti can be conservative, with physiotherapy and specific physical exercises, but, especially in case of concomitant hernia, surgery can be considered as the first choice of treatment in order to restore the midline and repair the hernia. Through recent years, a large amount of mini-invasive surgical techniques has been proposed, approaching the abdominal differently, and to date there is still lack of evidence on the optimal choice for surgeons and patients. So, the present review aims to give the reader an overview on the different techniques proposed, focusing on the three main categories of approaches (pre-aponeurotic, retro-muscular and pre-peritoneal), their specific features and results, with a view on the newly proposed robotic approaches that can theoretically reproduce each single technique.

Posterior component separation with transversus abdominis release (TAR) is a valuable adjunct to address incisional hernia defects. Currently, bilateral docking is a standard technique for robotic TAR. The aim of this study is to describe our technique for extended totally extraperitoneal (eTEP) repair with bilateral TAR through a bottom single-dock robotic approach for hernias at the level of the umbilicus or higher.

We retrospectively reviewed a case series of patients who underwent robotic eTEP repair with bilateral TAR using a single bottom docking between November 2021 and November 2023. A comprehensive description of our patient selection, surgical technique, and short-term clinical outcomes is reported.

Ten patients with incisional hernias were included. Their median age was 55 years (IQR: 49.5 to 61.25), 70% were male, the median BMI was 27.25 kg/m (IQR: 22.95 to 33.53), and ASA class was ≥2 in 80%. Median hernia width was 10 cm (IQR: 6.75 to 12.25) and length 11 cm (IQR: 9.25 to 16.25). The median operative time was 178.5 minutes (IQR: 153.75 to 222), and the length of stay was 1 day (IQR: 0.75 to 1.75). At a median follow-up of 5 months (IQR: 2.6 to 9.7), 20% of patients developed a surgical site occurrence requiring procedural intervention.

Bilateral TAR using a single bottom dock is a feasible and safe adjunct to robotic eTEP ventral hernia repair in appropriately selected patients.

The classic open ventral hernia repair provides excellent results in recurrences. However, wound complications are the Achilles heel for a good overall clinical outcome. Laparoscopic surgery is in general associated with less pain, better esthetic results, faster recovery, and lower incidence of wound complications. Robotic procedures provide increased degrees of freedom, may improve ergonomics, and allow scaling and performance of finer movements deemed difficult through alternate surgical approaches.

The aim of this study is to compare outcomes between open and minimally invasive approaches, with the primary objective of determining differences in postoperative course and hospitalization.

Patients underwent any of the three procedures: open Rives-Stoppa, laparoscopic eTEP or robotic eTEP between June 2020 and January 2024 for the treatment of one or more midline abdominal wall hernias alongside rectus abdominis diástasis. The width diameter of the hernias was between 3 and 10 cm and techniques that did not place the mesh in a retromuscular position or required component separation are excluded.

Robotic surgery had a lower score on the visual analogue scale for pain at discharge (p-value < 0.00). Minimally invasive surgery allows for the placement of larger meshes compared to the open approach (p < 0.05), although the surgical time is longer (p-value < 0.00). There were no statistically significant differences for hospital stay (p-value = 0.46), complications (p-value = 0.52) or recurrence (p-value = 0.70).

Minimally invasive surgery allows for the placement of larger meshes compared to the open approach without increasing the morbidity of the procedure or the immediate postoperative pain, despite generally having longer operative times.

The extended totally extraperitoneal (eTEP) repair has several theoretical advantages over the traditional intraperitoneal onlay mesh (IPOM) repair for ventral hernias, including the use of less expensive non-barrier coated mesh and avoiding complications of intraperitoneal mesh. However, one area in need of further investigation is cost and clinical comparisons following robotic eTEP with IPOM.

A retrospective matched cohort study was conducted of patients with midline ventral hernias undergoing robotic eTEP or IPOM at a single academic institution from November 2019-August 2023. Patients were matched based on demographics, hernia defect size, and whether they underwent concomitant procedures. Primary outcomes included supply costs. Secondary outcomes included operative time, length of stay, complications, recurrence, and inpatient opioid utilization.

In total, 88 matched patients were included: 44 IPOM and 44 eTEP. Mean age was 57 years, BMI 35 kg/m2, and 54.5% were male. Hernia size was similar for both groups: 25 [6-73] cm2 for the IPOMs vs 40 [14-68] cm2 for eTEPs (p = 0.21). There was no significant difference in total supply costs between IPOMs and eTEPs: $2338 [2021-3249] vs $2082 [1619-3394] (p = 0.5) respectively. Mean operative time was significantly lower for IPOMs 159.6 ± 57.8 min vs 198.0 ± 67.1 (p = 0.006), while the average length of stay was significantly longer for IPOMs: 1.7 ± 1.2 days vs 1.2 ± 1.3 days (p = 0.021). Total inpatient MME utilized was greater for IPOM: 61 [36-102] vs 29 [10-64] MME (p = 0.003). Postoperative complications and recurrence rate were similar.

There is no difference in total supply costs between patients undergoing robotic IPOM and eTEP repairs for midline ventral hernias. Though this study did find significant differences in total inpatient MME utilized and length of stay, it is debatable whether these are clinically significant. Further research is needed to determine appropriate indications for eTEP over IPOM.

Introduction: In the field of abdominal wall hernias, several innovative procedures have been developed, including the extended/enhanced-view totally extraperitoneal (eTEP) hernia repair technique. Initially introduced for laparoscopic hernia repair by J. Daes, it was subsequently applied to ventral hernia repair (VHR) and incisional hernia repair (IVHR) by I. Belyansky et al. This article presents the midterm experience and outcomes of our center's experience with the endoscopic technique based on the principles of eTEP during IVHR and VHR. Method: A review was conducted of a prospectively collected database of abdominal wall hernia. Patients who underwent eTEP VHR or IVHR between October 2018 and February 2021 were identified. Results: A total of 51 patients underwent an eTEP-RS or eTEP-TAR procedure, with a 24-month follow-up period. Of the 51 patients included in the study, 43 underwent eTEP-RS treatment, while 8 required an additional transversus abdominis release (3 unilaterally). One patient developed a large hematoma necessitating reoperation and drainage via the eTEP approach. Seven patients developed seromas, which were treated conservatively, while 2 patients experienced surgical site infections, which were managed with a single-use negative pressure wound therapy system. Two patients exhibited recurrence at sites above the epigastric edge of the mesh. Conclusion: Moreover, the advancement of minimally invasive surgical techniques for abdominal wall reconstruction has rendered the eTEP approach a viable option for both primary and incisional VHR, with promising midterm outcomes.

Primary ventral and incisional hernias are frequent conditions that impact the quality of life of patients. Surgical techniques for ventral hernia repair are constantly evolving and abdominal wall surgery has turned into a highly specialized field.

This is a narrative review of the most recent and relevant literature on the treatment of primary ventral and incisional hernias performed by eight experts in ventral hernia surgery from across the world and includes review of classification systems, preoperative measures, descriptions of surgical techniques, and postoperative complications.

Repairs of primary ventral and incisional hernias range from simple open procedures in healthy patients with small defects to complex procedures when patients are co-morbid and have large defects. Optimizing patient-related risk factors before surgery is important to decrease complication rates. Surgical repair techniques from open repairs to minimally invasive procedures are described in detail in the review. Minimally invasive techniques are technically more demanding and take longer, but decrease the risk of surgical-site infections and shorten the duration of hospital stay.

Treatment of ventral hernias aims to improve the quality of life of patients. The risks and benefits of procedures should be weighed against patients' complaints and co-morbidities. Optimizing patient-related risk factors before surgery is important.

There are many surgical techniques for ventral hernias and diastasis recti, both conventional or video-endoscopic, with or without mesh placement, detailed in the literature. Using some details of the techniques proposed by Wolfgang Reinpold (Mini- or Less Open Sublay Operation, MILOS) and Federico Fiori (Totally Endoscopic Sublay Anterior Repair, TESAR) we found modifications that allowed repairing and reinforcement of the posterior fascia with a retro-muscular mesh and achieve primary fascial closure by minimally umbilical access and searching for the best anatomical, functional, and aesthetic results.

Describe the surgical technique step by step and analyze 629 surgical treatments. The cohort comprises the period January 2018 to January 2023. Our Database registered 318 men and 311 women who underwent video endoscopicassisted Rives-Stoppa techniques to treat umbilical and epigastric hernias with diastasis RESULTS: All patients were treated on an outpatient basis and discharged home on the same day. The most frequent complications were seromas with conservative management. Other complications recorded were omphalitis in 6 patients, and three patients presented hematomas, one of whom performed surgical evacuation. There were ten patients with recurrences.

These hybrid approaches provide the advantages of mini-invasive techniques with a lower rate of complications and a high standard of quality of life, providing anatomical, functional, and aesthetic benefits.

The Rives-Stoppa (RS) procedure is a gold standard treatment of midline abdominal wall hernias. Comparability of pain control and outcomes to the enhanced-view totally extraperitoneal prosthetic (eTEP) repair remain unclear. A single-centre retrospective surgical cohort was selected including 30 RS repairs (January 2019-November 2021) and 30 consecutive eTEP procedures (September 2021-August 2022) for midline abdominal wall hernia(s) with rectus abdominis diastasis. Postoperative pain and outcomes were compared up to 1 month. Presence and median duration of patient-controlled analgesia were, respectively, 90% and 3 nights with RS, versus 30% and 0 nights with eTEP. Median switch to only oral analgesics occurred at postoperative day (POD) 3 after RS and at POD 2 after eTEP. Postoperative analgesics and opioid prescription at discharge were comparable. Median length of hospital stay was six nights after RS versus 3 nights after eTEP. Median duration of surgery was 110.5 and 164.5 min for RS and eTEP, respectively. After RS, 30 patients had postoperative drain(s) compared to 3 patients after eTEP. Conversion was needed in 3 eTEP procedures. Postoperative complications were comparable. No early recurrences were observed. Minimal residual diastasis was seen at postoperative consultation in 11 patients after eTEP. Compared to RS, eTEP is a minimally invasive alternative treatment of midline abdominal wall hernias with rectus abdominis diastasis and is associated with a shorter length of hospital stay, less postoperative pain and a comparable risk of short-term complications. At 1 month after eTEP, minimal residual diastasis can be present. ClinicalTrials.gov: NCT05446675. Secondary identifying number: EC/EH/220608-SK. Date of Registration: June 24, 2022.

Posterior component separation with transversus abdominis release (TAR) is considered to be the optimal technique for large incisional ventral hernia repair. Endoscopic TAR (eTAR) that gets all the benefits of minimally invasive surgery (MIS) gives a possibility to enhance results of the treatment. The aim of our study was to make the comparison between open and endoscopic TAR procedures with an emphasis on frequency and severity of postoperative complications in comparable groups.

All patients had midline incisional hernia and underwent either open (open TAR group) or endoscopic (eTAR group) Rives-Stoppa repair in combination with bilateral transversus abdominis release in Moscow City Hospital №1 from January 2018 to December 2022. A propensity score matching (PSM) was used to make groups comparable. Postoperative complications were classified according to Clavien-Dindo Classification, and Comprehensive complication index was calculated.

We performed 133 open and endoscopic TAR separation for midline incisional hernia. After PSM analysis 51 patients were matched to each group. Overall surgical morbidity in the open TAR group (56.9%) was statistically significantly higher than in the eTAR group (29.4%) (p = 0.009). There were more severe complications (Clavien IIIa-V) in the open TAR group (11.8% vs. 0%, p = 0.027). Length of hospital stay after surgery was shorter in eTAR group (p < 0.001). The Comprehensive complication index in the open TAR group was significantly higher than in eTAR group, 8.7 (0-20.9) vs. 0 (0-8.7) (p = 0.011).

Based on the data from our study, the entire MIS procedure including endoscopic TAR is a safe and optimal technique for surgery of midline incisional ventral hernia, requiring TAR separation in terms of reducing the rate of postoperative complications, their severity and hospital length of stay, compared to open TAR procedure.

The extended totally extraperitoneal technique (eTEP) is a relatively new laparoscopic approach to address ventral hernias. Since this technique is not widely used yet, the literature regarding its efficacy and safety is limited, especially when compared to more established surgical techniques like intraperitoneal onlay mesh (IPOM). This study aimed at contributing to the expanding body of evidence for eTEP, by comparing the early outcomes of eTEP and IPOM surgeries for ventral hernias.

This monocentric, retrospective cohort study compared patients with ventral hernias that were treated with eTEP or IPOM from 2019 to 2023.

A total of 123 patients were analysed. 92 underwent eTEP and 31 IPOM respectively. Both groups were overall comparable. The IPOM group had a higher proportion of incisional hernias (61,29% vs. 21,74%, p < 0,001). This was taken into account for in a subgroup analysis of only primary hernias. The IPOM group had a significantly longer admission time (eTEP: 3 days, IPOM: 4 days, p < 0,001). The subgroup analysis revealed a statistically significant shorter surgery time in IPOM (median of 66,5 min vs. 106,5 min; p = 0,043) and a lower rate of postoperative complications in eTEP (eTEP: 4,17%, IPOM: 25%. p = 0,009). The eTEP group reported lower postoperative pain, yet without statistical significance.

eTEP for ventral hernia repair appears to be non-inferior to IPOM. Compared to IPOM it leads to shorter postoperative hospital stay and a potentially lower complication rate, despite a longer operation time.

The aim was to evaluate results in terms of intra and postoperative complications, hospital stay, postoperative pain, functional recovery, aesthetic results and recurrence rate of totally endoscopic retromuscular hernia repair(eTEP-TAR)compared to conventional laparoscopic incisional hernia repair with defect closure(IPOM+)for right subcostal incisional hernias.

Data from consecutive patients requiring conventional minimally invasive subcostal incisional hernia repair collected from January 2014 to December 2018 were compared with patients underwent eTEP from January 2019 to July 2024 in a case-control study.

51 patients in the IPOM + group and 46 in eTEP group were included.Both groups were comparable considering demographic variables.No significant differences were identified in mean defect length (6,6+/-1,4 vs. 7,5+/-1,2 cm, p = 0,08) or width(6,3+/-1,5 vs. 5,9+/-1,4 cm, p = 0,3).The mean mesh area was significantly bigger in eTEP group(907,9+/-136,4 vs. 631,5+/-129,3 cm2,p < 0,05)with significant longer surgical time (106,3+/-22,7 vs. 67,2+/-15,5 min, p = 0,03).No differences in intraoperative complications were identified.Hospital stay was significantly improved in eTEP group when compared to IPOM + group (33,6+/-13,8 vs. 61,09+/-12,2 hours, p = 0,03).Postoperative complications were significantly higher in the IPOM + group due to postoperative ileus (9% vs. 2%,p < 0,05).One recurrence was identified in eTEP group(2%), and 2 recurrences in IPOM + group(3%) with an average follow-up of 20.6+/-10.6 months and 60.6+/-10.6 months respectively. eTEP group showed significantly lower pain on the 1st -7th -30th -90th postoperative days than IPOM + group.Functional recovery was significantly improved in the eTEP group one and six months after surgery.No differences in terms of cosmetic results were identified.

eTEP-TAR for subcostal hernias shows lower postoperative pain and hospital stay with better functional recovery than IPOM+,without differences in recurrence rate and cosmesis result.Postoperative ileus is increased when intraperitoneal mesh is laparoscopically placed. eTEP-TAR in subcostal hernia repair requires significant higher operative time due to its complexity.

There is a growing consensus on the benefits of retro-muscular (RM) mesh positioning, highlighted by its recommendation in the latest edition of EHS guidelines. The eTEP method has facilitated minimally invasive hernia repairs with retro-muscular mesh placement. With the increasing availability of robotic systems, there has been a corresponding increase in robotic adaptations of minimally invasive techniques involving retro-muscular mesh placement.

All patients who underwent robotic ventral hernia repair using the lateral extraperitoneal eTEP technique at Kempten Hospital between September 2019 and December 2023 were includes in the study. Preoperative characteristics, perioperative parameters, postoperative parameters, and hernia-specific parameters, were retrospectively analyzed using the hospital information system.

160 patients were operated using a lateral approach eTEP technique during the observation period, 111 (69.38%) for incisional hernia repair and 49 (30.63%) for primary hernia repair. 43 cases required TAR (30 unilateral TAR and 13 bilateral TAR). 139 patients had a medial (86.98%), seven patients (4.14%) a lateral and 14 patients (8.88%) a combined hernia defect. The median operative time was 143 min (range: 53 min-495 min). The median length of hospital stay was 3 days (range: 2-16). There was one intraoperative complication. The postoperative complication rate was 6.25% (10 patients), with 1.72% (2 patients) requiring reoperation. Sonographic follow-up examinations revealed seromas in 5 patients, with 4 located in the retromuscular mesh space and 1 in the former hernia sac. None of these seromas required surgical intervention.

The "lateral approach" of robotic eTEP provides a safe surgical method for treating ventral hernias using minimally invasive techniques and mesh augmentation in the retro-muscular space. Further studies are necessary to compare extraperitoneal with transperitoneal methods.

The deep inferior epigastric perforator (DIEP) flap for autologous breast reconstruction is associated with higher patient satisfaction and fewer abdominal morbidities at the donor site than the transverse rectus abdominis myocutaneous flap. However, abdominal bulging occurs at a certain frequency, and there is no established treatment. Here, we present a case of laparoscopic hernia repair using the enhanced-view totally extraperitoneal (eTEP) method in a patient with a lower abdominal bulge after DIEP flap reconstruction.

A 53-year-old woman underwent left nipple-sparing mastectomy, left axillary lymph node dissection, and breast reconstruction with a DIEP flap for left breast cancer 3 years previously. We performed an eTEP method for an abdominal bulge. The absence of a hernia sac facilitated dissection of the retrorectal space, and a left-sided transversus abdominis release was performed, followed by mesh placement. No postoperative abdominal bulging was observed.

Using the eTEP method for repairing an abdominal bulge after DIEP flap reconstruction is advantageous because it facilitates a relatively straightforward dissection of a wide area of the retrorectal space without a hernia sac.

Transabdominal preperitoneal (TAPP) ventral hernia repair requires incising the peritoneum from within the abdominal cavity, developing a flap, and placing a reinforcing mesh after fascial closure from the preperitoneal space. We present a novel adaptation to this technique that allows placement of preperitoneal mesh without entering the abdominal cavity. The robotic totally extra- and preperitoneal (R-PeTEP) access for ventral hernia repair is best suited for small to moderate sized ventral hernias with concomitant diastasis recti.

Our study is a retrospective review of all patients who underwent R-PeTEP from December 2022 to November 2023. A comprehensive description of the surgical technique is included. Patient demographics, hernia characteristics, as well as clinical outcomes are described.

A total of 25 patients underwent R-PeTEP for ventral hernia repair with diastasis recti plication. The median age was 55 years (IQR 43.5-63) and 92% (n = 23) were male. The median ASA score was 2 (IQR 1-2) and the median BMI was 30.4 (IQR 29.3-32.8) with 64% (n = 16) percent having a BMI ≥ 30. Median hernia width was 3 cm (IQR 3-4), with a median diastasis recti width of 4 cm (IQR 2.6-4) and length of 15 cm (IQR 11.8-16). The median operative time was 120 min (IQR 116-134). All repairs were reinforced with permanent mesh. Sixty-eight percent of the patients (n = 17) were discharged on the same day. With a median follow-up of 30 days (IQR 16-107), 8% (n = 2) seromas, 16% (n = 4) developed clinically insignificant hematomas, and one patient (4%) developed ileus that was managed conservatively.

This study establishes the feasibility and safety of R-PeTEP, which provides direct access to the preperitoneal space, avoiding disruption to the posterior rectus sheath, possibly reducing neurovascular bundle injuries, and omitting entry to the abdominal cavity. R-PeTEP facilitates wide flap creation for prosthetic overlap and allows for posterior plication of diastasis recti with little to no mesh fixation with overall excellent preliminary clinical outcomes.

Barbed sutures (BS) have been increasingly used in the last two decades across surgical disciplines but little is known about how widespread their adoption has been in ventral hernia repair (VHR). The aim of this study was to document the use of barbed sutures in VHR in a multicenter database with associated clinical and patient-reported outcomes.

Prospectively collected data from the Abdominal Core Health Quality Collaborative database was retrospectively reviewed, including all adult patients who underwent VHR with fascial closure from 2020 to 2022. A univariate analysis compared patients with BS against non-barbed sutures (NBS) across the preoperative, intraoperative, and postoperative timeframes including patient-reported outcomes concerning quality of life and pain scores.

A total of 4054 patients that underwent ventral hernia repair with BS were compared with 6473 patients with non-barbed sutures (NBS). Overall, BS were used in 86.2% of minimally invasive ventral hernia repairs and about 92.2% of robotic surgery compared to only 9.6% of open procedures. Notable differences existed in patient selection, including a higher BMI (32 vs 30.5; p < 0.001), more incisional hernias (63.3% vs 51.1%; p < 0.001), wider hernias (4 cm vs 3 cm; p < 0.001), and higher ASA score (p < 0.001) in patients with BS. Outcomes in patients with BS included a shorter length of stay (mean days; 1.4 vs 2.4; p < 0.001), less SSI (1.5% vs 3.6%; p < 0.001), while having similar SSO (7.6% vs 7.3%; p = 0.657), readmission (3.0 vs 3.2; p = 0.691), and reoperation (1.5% vs 1.45%; p = 0.855), at a longer operative time (p < 0.001). Hernia-specific questionnaires for quality of life (HerQLes) and pain in patients with BS had a worse preoperative score that was later matched and favorable compared to NBS (p = 0.048). PRO concerning hernia recurrence suggest around 10% at two years of follow-up (p = 0.532).

Use of barbed sutures in VHR is widespread and highly related to MIS. Outcomes from this multicenter database cannot be reported as superior but suggest that barbed sutures do not have a negative impact on outcomes.

Abdominal wall reconstruction (AWR) is a treatment option for structural defects of the abdominal wall. The most frequently cited publications related to AWR have not been quantitatively or qualitatively assessed. This bibliometric analysis characterizes and assesses the most frequently cited AWR publications, to identify trends, gaps, and guide future efforts for the international research community.

The 100 most cited publications in AWR were identified on Web of Science, across all available journal years (from May 1964 to December 2023). Study details, including the citation count, main content focus, and outcome measures, were extracted and tabulated from each publication. Oxford Centre for Evidence-Based Medicine levels of evidence (LOE) of each study were also assessed.

The 100 most cited publications in AWR were cited by a total of 9674 publications. Citations per publication ranged from 43 to 414 (mean 96.7 ± 52.48). Most publications were LOE 3 (n = 60), representative of the large number of retrospective cohort studies. The number of publications for LOE 5, 4, 3, 2, and 1 was 21, 2, 60, 2, and 12, respectively. The main content focus was surgical technique in 44 publications followed by outcomes in 38 publications. Patient-reported outcome measures were used in 3 publications, and no publications reported validated esthetic outcome measures.

Overall, 3 was the LOE for most frequently cited AWR publications, with more publications below LOE 3 than above LOE 3. Validated outcome measures and patient-reported outcome measures were infrequently incorporated in the studies evaluated.

The aim of this work is to describe the rational, feasibility and clinical and Quality-of-life improvement results of a fully endoscopic preperitoneal repair for midline and lateral abdominal wall hernias, starting from the space of Retzius in a "bottom-to-up" approach.

An observational prospective data-collected and quality of life study is performed in selected patients with less than 10 cm. in diameter midline and lateral abdominal wall hernias. A suprapubic upward e-TEP technique from a previously dissected Retzius space, is performed in all cases. The surgical goal is to perform a total free-tension abdominal wall reconstruction followed by a prosthetic hernioplasty. Clinical Data is classified in preoperative, intraoperative, and postoperative variables, including a quality-of-life clinical evaluation based on an improvement of HerQLes score.

A total of 30 patients underwent this approach from September 2017 to October 2022 in a single-surgeon practice. A total restoration of the previous abdominal wall anatomy and a prosthetic repair were achieved in all cases. The mean operative time was 142.53 min, with a significant shorter time in lateral hernias approach. Minor complications (Clavien-Dindo I) were collected in 10% of the patients. Major complications (Clavien-Dindo IIIb) occurred in 6.66% of the patients. The mean pain at discharge was 1.83 VAS, with a significant lower pain in M-eTEP approach for lateral hernias. The mean hospital stay was 42.4 h. No seroma, hematoma, chronic pain, or recurrence was observed in the mean follow-up (20.33 months). A clinical and quality of life improvement was found in 92.9% of the patients, measured by a minimal clinical important difference (MCID) between preoperative and postoperative HerQLes score.

Despite being a technically demanding approach, the results obtained by this approach are compatible in safety and feasibility with other minimally invasive preperitoneal hernia repair techniques, in addition to obtaining a significant improvement in the quality of life of patients.

The objective of this study was to perform a systematic review and meta-analysis to summarize various approaches in performing minimally invasive posterior component separation (MIS PCS) and ascertain their safety and short-term outcomes.

A systematic literature searches of major databases were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to identify studies that provided perioperative characteristics and postoperative outcomes of MIS PCS. Primary outcomes for this study were: surgical site events (SSE), surgical site occurrence requiring procedural intervention (SSOPI), and overall complication rates. A random-effect meta-analysis was conducted which allows computation of 95% CIs using simple approximation and incorporates inverse variance method with logit transformation of proportions.

There were 14 studies that enrolled 850 participants that were included. The study identified rate of SSE, SSOPI, and overall rate of complications of all MIS TAR modifications to be 13.4%, 5.7%, and 19%, respectively.

Our study provides important information on safety and short-term outcomes of MIS PCS. These data can be used as reference when counseling patients, calculating sample size for prospective trials, setting up targets for prospective audit of hernia centers. Standardization of reporting of preoperative characteristics and postoperative outcomes of patients undergoing MIS PCS and strict audit of the procedure through introduction of prospective national and international registries can facilitate improvement of safety of the MIS complex abdominal wall reconstruction, and help in identifying the safest and most cost-effective modification.

Although the enhanced-view totally extraperitoneal (eTEP) approach has demonstrated safety, efficacy, and durability for small- to medium-sized hernia repairs, the relationships between retrorectus insufflation, intraoperative respiratory stability, and end-tidal CO2 (ETCO2) levels has not been appraised.

We conducted a retrospective chart review of patients undergoing elective robotic-assisted ventral hernia repairs at our quaternary academic center from July 2018 through December 2021. Patients were grouped by repair technique, either eTEP or robotic transversus abdominis release (r-TAR). Baseline demographics, intraoperative anesthesia records, and perioperative outcomes were reviewed. Anesthesia data were collected at intubation and 30-min time intervals thereafter. Operative time, length of stay, patient-controlled anesthesia use, and perioperative complications were compared.

In total, 205 patients underwent an eTEP repair and 97 patients underwent an r-TAR repair. Intraoperatively, eTEP repairs had significantly higher ETCO2 at the beginning of the case (times 1-4, P < 0.05), and a higher peak ETCO2 (P < 0.05) when compared to r-TAR repairs. This difference in ETCO2 desisted as the case progressed, with a subsequent increase in respiratory rate (times 2-6, P < 0.05) in the eTEP procedures. The eTEP group demonstrated significantly shorter operative times, decreased patient-controlled anesthesia use, and a shorter length of stay. There was no significant difference in postoperative intensive care unit admission or respiratory distress.

This study demonstrates that retrorectus insufflation during eTEP hernia repairs correlated with higher levels of ETCO2 compared to r-TAR repairs yet was not associated with any meaningful difference in perioperative outcomes. Communication of these respiratory differences with anesthesia is needed for proper ventilation adjustments.

The popularity of endolaparoscopic extraperitoneal repairs has been on the rise due to advantages such as sublay mesh placement and early return to daily activities. However, the procedure requires overcoming a learning curve, and with increased adoption, new complications have emerged. One significant complication is the rupture of the posterior rectus sheath (PRS). In this article, we present our modifications of the technique to reduce tension during PRS closure.

The study included 105 patients who underwent endolaparoscopic extraperitoneal repairs for ventral hernias using two different techniques. Group A ( n = 68) underwent the original technique, whereas Group B ( n = 37) underwent the modified technique. The modifications in Group B included preserving the peritoneal bridge between the two PRS and the hernia sac, conducting a complete dissection of the space of Bogros and adopting a transverse or oblique closure of PRS along the lines of least tension. To assess the efficacy of these modifications in preventing PRS rupture, we compared the results of both groups.

Our findings indicate that following all the technical steps of the modified technique resulted in a reduced need for transversus abdominis release for PRS closure and a lower incidence of PRS rupture in the postoperative period. However, to further validate the effectiveness of these modifications, a larger follow-up period and a bigger sample size are required.

The adoption of the modified technique can help achieve a tension-free PRS closure.

To present a novel technique of preperitoneal cross-over for eTEP VHR.

Patients who underwent robotic eTEP with mesh utilizing a preperitoneal cross over technique were identified using a single-institution hernia database. This novel technique involves minimally invasive access to the retro-rectus space on one side with midline cross over into the preperitoneal space on the contralateral side. Baseline demographics of the patients were obtained, and intra-operative and post-operative outcomes were reported.

Nine VHR patients underwent robotic eTEP with mesh using a preperitoneal crossover technique. Five patients were male, mean age was 53 ± 18.4 years, and mean BMI was 32.5 ± 4.2 kg/m2. Two patients were diabetic and 2 were previous smokers. Two of the hernias were recurrent. The average hernia defect was 96.9 ± 45.5 cm2 and the average mesh size was 593.3 ± 168.2 cm2. Four patients underwent a unilateral TAR, while five patients did not require any component separation. All cases were CDC Class 1 wounds. All patients met discharge criteria on post-operative day 1. There was one post-operative wound occurrence which was a seroma. There were no infectious complications and no hernia recurrences. The average follow up was 1.4 ± 1.2 months.

Preperitoneal cross-over during eTEP ventral hernia technique is a safe technique that allows placement of a large extra-peritoneal mesh. Early patient outcomes are favorable. Larger sample size and follow-up are needed to truly assess postoperative outcomes.

Incisional hernia (IH) is an abdominal wall defect due to a previous laparotomy, and surgical repair is the only treatment. IH has a negative impact on patients' quality of life. In the last decades, the approach has improved from open to laparoscopic and robotic surgery with the objective of promoting better abdominal wall function after reconstruction. Today, robotic enhanced-view totally extraperitoneal (reTEP) is one of the most advanced techniques for abdominal wall reconstruction.

The aim of this study was to analyze the early results of patients with incisional hernia submitted to repair with reTEP.

This is a retrospective cohort study, and all patients who underwent reTEP surgery for ventral hernia in the years 2021 and 2022 were included. The only exclusion criteria were patients who underwent another type of herniorrhaphy. Statistical analysis was performed using the Stata software.

A total of 32 participants were submitted to reTEP; the majority had an incisional hernia, and according to the European Hernia Society, EUS-M score 3 was the most prevalent. The mean surgical time was 170 min, and the console time was 142 min. Most patients stayed 2 days in the hospital. No intraoperative complications were reported.

reTEP is a safe and effective technique and has favorable outcomes in the early postoperative period. Further studies with larger sample sizes and longer follow-up periods are needed to confirm these findings.

Options for minimally invasive ventral hernia repair continue to evolve as a function of our understanding of the abdominal wall and the development of new techniques. We describe a robotic transabdominal pre-peritoneal repair with concurrent rectus aponeuroplasty (TAPPRA) for incisional and recurrent ventral hernias.

All patients in this retrospective cohort study underwent TAPPRA repair between October 2023 and March 2024. This study aimed to determine intraoperative feasibility of the technique and to assess immediate postoperative outcomes.

Twelve patients underwent TAPPRA repair for incisional and/or recurrent ventral hernias at an academic hernia center. The median case duration was 135 min with no significant intraoperative complications noted. Average defect size for the hernias measures 6.5 × 8.5 cm. Polypropylene mesh was used to reinforce all defects, with the average dimensions being 19.7 × 21.5 cm. 83% of patients were discharged within 24 h of their procedure. No significant postoperative complications were noted.

We describe the first use of a novel ventral hernia repair technique, TAPPRA, and demonstrate that it is safe, feasible, and associated with appropriate short-term outcomes for repair of moderate sized incisional hernias.

The totally preperitoneal (TPP) approach is a new concept that was recently introduced. Although the TPP approach combined with single-incision laparoscopic hernia repair has its own advantages, there is little evidence reflecting the characteristics and feasibility of either approach.

To analyze the potential applications of single-incision laparoscopic TPP (SIL-TPP) inguinal hernia hernioplasty for the treatment of inguinal hernias.

A total of 152 SIL-TPP surgeries were performed at the First Affiliated Hospital of Ningbo University from February 2019 to November 2022. A single-port, named Iconport, and standard laparoscopic instruments were used during the operation. Demographic data, intraoperative parameters and short-term postoperative outcomes were collected and retrospectively analyzed.

The demographic data of 152 patients underwent SIL-TPP were shown in Table 1. The average age was 49.5 years (range from 21 to 81 years). The average body mass index was 27.7 kg/m2 (range from 17.7 kg/m2 to 35.6 kg/m2). SIL-TPP were conducted successfully in 147 patients. Three patients were converted to the SIL-transabdominal preperitoneal laparoscopic herniorrhaphy at the initial stage of the study due to a lack of experience. In 2 patients with incisional hernias, an auxiliary operation hole was added during the SIL-TPP procedure, as required for surgery. The mean operative time was 64.5 minutes (range: 36.0-110.0 minutes) for unilateral direct and femoral hernias and 81.6 minutes for indirect hernias (range: 40.0-150.0 minutes). The mean postoperative hospital stay was 3.4 days.

SIL-TPP is feasible and has advantages for inguinal hernia repair. SIL-TPP has potential benefits for patients with various abdominal wall hernias. Consequently, doctors should be encouraged to actively apply the TPP approach combined with a single incision in their daily work.

Many minimally invasive techniques have been developed over the years to treat primary ventral hernias and rectus abdominis diastasis, all of which have their advantages and disadvantages in terms of complications, reproducibility, and cost. We present a case-series of a novel approach that was safe and reproducible in a cohort of 17 patients.

All patients in the study underwent the novel procedure between October 2022 and July 2023. We collected data retrospectively, including patient general characteristics, surgical outcomes, and complications. Patient follow-up lasted 12 months to exclude recurrences.

Seventeen patients underwent the procedure for primary uncomplicated ventral hernias and rectus diastasis. The median length of hospital stay was 2 days (IQR 2-3). In 4 out of 17 cases minor complications occurred within 30 days, of which 3 were class I and 1 was a class II complication according to the Clavien-Dindo classification. There were no recurrences.

Although limited by a small cohort of patients and a non-comparative study design, our study presents encouraging results in regards to the safety of this technique. More studies with a larger study population are needed to evaluate the benefits and pitfalls of this new technique.[query names].

Introduction: This report aimed to compare ventral extended vision extraperitoneal (ETEP) and preaponeurotic repair (REPA) techniques in terms of surgical procedure, outcomes, and patient evolution. Methods: This was a retrospective study performed at a tertiary care academic center between 2017 and 2022. All consecutive patients operated on for midline hernias and rectus diastasis using REPA and ETEP were included. Follow-up visits were at 15 days, 30 days, and 6 months postoperative. Age, sex, BMI, American Surgical Anesthesiologic Classification (ASA), surgical time, need for conversion to open surgery, time of stay, seroma, hematoma, surgical site infection (SSI), recurrence, and re-interventions were assessed. Results: For the present study, 148 patients were included. From them, 62 patients received the REPA procedure and 86 were operated on using the ETEP technique. REPA average time was 105 minutes (interquartile range [IR] 80-130), and ETEP average time was 120 minutes (RIC 95-285) (p = 0.03). Ambulatory procedures were 32.3% (n = 20) REPA and 20.9% (n = 18) ETEP (p = 0.23). In REPA, the mean time for drain extraction was 11.92 days and 8 days in ETEP (p < 0.001). Seroma incidence was identified in 40.3% (n = 25) of the REPA cases and 5.8% (n = 5) of the ETEP procedures (p = 0.001). In a multivariate analysis for seroma incidence REPA technique was associated with a significant risk of its incidence [odds ratio (OR) 16, 67 95% confidence interval ((CI95) 4.67-59.52), p < 0.001]. Conclusion: REPA and ETEP are safe and reproducible. Both approaches reported short hospitalization times and almost no major complications. We found a longer surgical time in ETEP and a higher incidence of seroma in REPA.

Ventral hernia repair (VHR) is one of the most common procedures in the United States, and drains are used in over 50% of mesh repairs. The aim of this study is to investigate the impact of drains on surgical site occurrences (SSO) and infection (SSI) after open and minimally invasive retromuscular VHR with mesh.

A retrospective review of prospectively collected data from the ACHQC was performed to include adult patients who underwent elective VHR with retromuscular mesh placement. Univariate analysis was performed comparing drain and no-drain groups. A logistic regression was performed to identify factors independently associated with increased SSO, SSI, readmission, and length of stay (LOS).

6945 patients underwent elective VHR with sublay mesh. Most patients had M2 and M3 hernias in both groups (with Drain and no-drain). The median LOS was 4.7 (SD 8.3) in the drain group and 1.6 (SD 8.4) in the no-drain group (p < 0.001). 30-day SSI was higher in the drain group (176; 3.8% vs 25; 1.1%; p < 0.001). Despite lower SSO overall in the drain group (470; 10.0% vs 286; 12.7%; p < 0.001), SSO or SSI requiring intervention (SSOPI) was higher in the drain group (240; 5.1% vs 44; 1.9%; p < 0.001). Logistic regression identified diabetes (OR 1.3, CI 1.1-1.6; p < 0.001) and BMI (OR 1.04, CI 1.03-1.05; p < 0.001) as predictors of SSO, while the use of a drain was protective (OR 0.61; CI 0.5-0.8; p < 0.001). For SSI, logistic regression showed diabetes (OR 1.6, CI 1.2-2.3; p = 0.004) and open approach (OR 3.5, CI 2.1-5.9; p < 0.001) as predictors.

Drain placement during retromuscular VHR with mesh was predictive of decreased postoperative SSO occurrence but associated with increased LOS. Diabetes and open approach, but not drain use, were predictors of SSI.

Several recent meta-analyses have identified the retromuscular plane as the preferred mesh position in ventral hernia repair. Open surgery used to be the standard technique for these procedures. However, new minimally invasive techniques with totally extraperitoneal access and mesh positioning in the retromuscular plane have evolved.

Between September 2018 and March 2019, 18 consecutive patients with ventral hernia were treated endoscopically in the totally extraperitoneal technique. Depending on the localisation and size of the hernia, the appropriate access was chosen and an uncoated mesh was placed in the retromuscular space in all patients. Data of patients' characteristics as well as peri- and postoperative parameters were collected. One year after surgery, patients were asked about recurrence, pain and complications, using the questionnaire of the herniamed data base.

No intraoperative complications were noted. Postoperatively, there was one retromuscular seroma that did not need treatment, one temporary paralysis of the radial nerve and one pulmonary embolism. None of these complications led to persistent problems. 17 of 18 patients were available for follow-up. One year follow-up showed no hernia recurrence. One patient had pain at rest requiring treatment.

Totally extraperitoneal endoscopic hernia surgery is a safe and promising new technique that is also feasible in complex hernias and with satisfactory 1 year results. This technique can combine the advantages of minimally invasive surgery with those of extraperitoneal mesh placement.