LAPAROSCOPIC ETEP (EXTENDED TOTALLY EXTRAPERITONEAL REPAIR) VENTRAL HERNIA SURGERY – RESULTS FROM 2021/2022
Goran T. Andersen*, Erik A. ELDEN, Dmitrij Vorontsov, Hallvard Græslie
Department of Surgery, Sykehuset Namsos, Namsos, Norway
Introduction. Previously in our department of surgery, hernia repair of ventral hernias was conducted by laparoscopic intraperitoneal onlay mesh repair (IPOM+). We recently changed to laparoscopic ETEP surgery with retromuscular mesh placement as our preferred technique for ventral hernia surgery – both for primary ventral hernias and for recurrent hernias with previous implants. This abstract presents our results so fare for 17 cases operated with ETEP surgery in 2021 and 2022.
Results: These 17 patients (median age 62 years, median ASA class 2 and median BMI 26) constitutes a heterogenus sample of patients related to hernia complexity - from umbilical hernias with diastasis recti to large ventral hernias with previous implants. Our operation time for these cases reflects this with a range from 122 minutes to 420 minutes, median 195 minuntes. The length of hospital stay had a range in days (1-12), median 3 days. ETEP surgery with only hernia related intraabdominal exposure was successful for 14 patients. For three patients we had to convert to intraabdominal laparoscopy to perform the retromuscular dissection. Two cases needed bilateral TAR, and three patients needed unilateral TAR. Two patients had hybrid surgery with a combination of laparascopic and open reconstruction of the abdominal wall. For postoperative surgical complications, three patients had postoperative bleeding with one of them needing laparoscopic reoperation the first day after surgery. The patient follow up consisted of one clinical control with CT scan 1-3 months after surgery and one final follow up with CT scan one year after surgery. CT scans of all patients 1-3 months after surgery shows adequate abdominal wall reconstruction and for a nine patients we have 12 months follow up CT scans with satisfactory outcome. So fare in our results, we have not had any clinical significant seroms or any wound or mesh infections. Related to recurrence rate, one patient have developed a port site herniation in the upper abdomen after ETEP for a low midline hernia.
Conclusion/discussion Based on these preliminary results, laparoscopic retromuscular mesh placement with ETEP surgery is a promising technique that gives better anatomical abdominal wall reconstruction than IPOM. There is also no need for mesh fixation with transfascial sutures or tackers with this method and this will probably reduce the risk for chronic abdominal wall pain with nerve entrapment after hernia surgery. With better equipment (robotic assisted surgery) and more experience with the ETEP, we expect reduction of the operation time and the length of the hospital stay.
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