Abdominal Wall Hernias
Conventional and popular surgeries for ventral hernias are open onlay mesh hernioplasty, open retromuscular mesh hernioplasty (Rives-Stoppa procedure) and laparoscopic intraperitoneal mesh hernioplasty.
Evidence suggests that retromuscular mesh hernioplasty has advantages over other procedures regarding recurrence and surgical site occurrences. An alternative strategy has been developed for this setting where a mesh is placed in retromuscular space by minimal access technique of the extended Totally Extraperitoneal approach (eTEP).
Extended totally extraperitoneal repair (eTEP) is a novel technique that was first introduced by Jorge Daes in 2012 to address difficult inguinal hernias.The principle is to create a larger space than what is done in TEP ( the usual laparoscopic hernia tepair) to tackle large groin hernias.Some surgeons have extended the indication to ventral hernias with the purpose to place the mesh in the retromuscular space, This has been called Extended Totally Extraperitoneal RS repair (eTEP RS). When the defect is too wide to be closed without tension, a muscle component separation procedure is added. Generally, the posterior component separation technique (PCST) in the form of Transversus abdominis release (TAR) (pioneer Dr. Novitsky)is preferred with the eTEP technique since the plane of dissection is the same. This is called eTEP TAR. It is believed that mesh placement in retromuscular space translates into vascularisation of the mesh from both sides and hence better incorporation in the body, less recurrence, fewer issues of fixation, less pain and fewer chances of bowel adhesions in addition to being economical due to the deployment of a cheaper mesh as composite mesh with anti-adhesion barrier is not needed.However, the technique has a steep learning curve. ( Gentle for patient but Taxing for the Surgeon )
We have been offering this novel technique for most of our patients with dramatic results