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Erschienen in: Surgical Endoscopy 3/2018

15.09.2017

A novel approach using the enhanced-view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair

verfasst von: Igor Belyansky, Jorge Daes, Victor Gheorghe Radu, Ramana Balasubramanian, H. Reza Zahiri, Adam S. Weltz, Udai S. Sibia, Adrian Park, Yuri Novitsky

Erschienen in: Surgical Endoscopy | Ausgabe 3/2018

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Abstract

Background

The enhanced-view totally extraperitoneal (eTEP) technique has been previously described for Laparoscopic Inguinal Hernia Repair. We present a novel application of the eTEP access technique for the repair of ventral and incisional hernias.

Methods

Retrospective review of consecutive laparoscopic retromuscular hernia repair cases utilizing the eTEP access approach from five hernia centers between August 2015 and October 2016 was conducted. Patient demographics, hernia characteristics, operative details, perioperative complications, and quality of life outcomes utilizing the Carolina’s Comfort Scale (CCS) were included in our data analysis.

Results

Seventy-nine patients with mean age of 54.9 years, mean BMI of 31.1 kg/m2, and median ASA of 2.0 were included in this analysis. Thirty-four percent of patients had a prior ventral or incisional hernia repair. Average mesh area of 634.4 cm2 was used for an average defect area of 132.1 cm2. Mean operative time, blood loss, and length of hospital stay were 218.9 min, 52.6 mL, and 1.8 days, respectively. There was one conversion to intraperitoneal mesh placement and one conversion to open retromuscular mesh placement. Postoperative complications consisted of seroma (n = 2) and trocar site dehiscence (n = 1). Comparison of mean pre- and postoperative CCS scores found significant improvements in pain (68%, p < 0.007) and movement limitations (87%, p < 0.004) at 6-month follow-up. There were no readmissions within 30 days and one hernia recurrence at mean follow-up of 332 ± 122 days.

Conclusions

Our initial multicenter evaluation of the eTEP access technique for ventral and incisional hernias has found the approach feasible and effective. This novel approach offers flexible port set-up optimal for laparoscopic closure of defects, along with wide mesh coverage in the retromuscular space with minimal transfascial fixation.
Literatur
1.
Zurück zum Zitat LeBlanc KA, Booth WV (1993) Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc 3:39–41 PubMed LeBlanc KA, Booth WV (1993) Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc 3:39–41 PubMed
2.
Zurück zum Zitat Heniford BT, Park A, Ramshaw BJ et al (2003) Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg 238:391–399 PubMedPubMedCentral Heniford BT, Park A, Ramshaw BJ et al (2003) Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg 238:391–399 PubMedPubMedCentral
3.
Zurück zum Zitat Orenstein SB, Dumeer JL, Monteagudo J et al (2011) Outcomes of laparoscopic ventral hernia repair with routine defect closure using “shoelacing” technique. Surg Endosc 25(5):1452–1457 CrossRefPubMed Orenstein SB, Dumeer JL, Monteagudo J et al (2011) Outcomes of laparoscopic ventral hernia repair with routine defect closure using “shoelacing” technique. Surg Endosc 25(5):1452–1457 CrossRefPubMed
4.
Zurück zum Zitat Earle D, Roth JS, Saber A et al (2016) SAGES guidelines for laparoscopic ventral hernia repair. SAGES Guidelines Committee. Surg Endosc 30(8):3163–3183 CrossRefPubMed Earle D, Roth JS, Saber A et al (2016) SAGES guidelines for laparoscopic ventral hernia repair. SAGES Guidelines Committee. Surg Endosc 30(8):3163–3183 CrossRefPubMed
6.
Zurück zum Zitat Wake BL, McCormack K, Fraser C et al (2005) Transabdominal preperitoneal (TAPP) vs totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair. Cochrane Database Syst Rev. doi: 10.​1089/​lap.​2008.​0212 PubMed Wake BL, McCormack K, Fraser C et al (2005) Transabdominal preperitoneal (TAPP) vs totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair. Cochrane Database Syst Rev. doi: 10.​1089/​lap.​2008.​0212 PubMed
7.
Zurück zum Zitat Leibl BJ, Jager C, Kraft B et al (2005) Laparoscopic hernia repair TAPP or/and TEP? Langenbecks Arch Surg 390:77–82 CrossRefPubMed Leibl BJ, Jager C, Kraft B et al (2005) Laparoscopic hernia repair TAPP or/and TEP? Langenbecks Arch Surg 390:77–82 CrossRefPubMed
8.
Zurück zum Zitat Prasad P, Tantia O, Patle NM (2011) Laparoscopic ventral hernia repair: a comparative study of transabdominal preperitoneal versus intraperitoneal onlay mesh repair. J Laparoendosc Adv Surg Tech A. 21(6):477–483 CrossRefPubMed Prasad P, Tantia O, Patle NM (2011) Laparoscopic ventral hernia repair: a comparative study of transabdominal preperitoneal versus intraperitoneal onlay mesh repair. J Laparoendosc Adv Surg Tech A. 21(6):477–483 CrossRefPubMed
9.
Zurück zum Zitat Belyansky I, Zahiri HR, Park A (2016) Laparoscopic transversus abdominis release, a novel minimally invasive approach to complex abdominal wall reconstruction. Surg Innovation 23(2):134–141 CrossRef Belyansky I, Zahiri HR, Park A (2016) Laparoscopic transversus abdominis release, a novel minimally invasive approach to complex abdominal wall reconstruction. Surg Innovation 23(2):134–141 CrossRef
10.
Zurück zum Zitat Daes J (2012) The enhanced view–totally extraperitoneal technique for repair of inguinal hernia. Surg Endosc 26(4):1187–1189 CrossRefPubMed Daes J (2012) The enhanced view–totally extraperitoneal technique for repair of inguinal hernia. Surg Endosc 26(4):1187–1189 CrossRefPubMed
11.
Zurück zum Zitat Daes J (2016) The extended-view totally extraperitoneal e-TEP technique for inguinal hernia repair. In: Novitsky YW (ed) Hernia surgery, current principles. Springer, NewYork, pp 467–472 Daes J (2016) The extended-view totally extraperitoneal e-TEP technique for inguinal hernia repair. In: Novitsky YW (ed) Hernia surgery, current principles. Springer, NewYork, pp 467–472
12.
Zurück zum Zitat Heniford BT, Walters AL, Lincourt AE et al (2008) Comparison of generic versus specific quality-of-life scales for mesh hernia repairs. J Am Coll Surg 206(4):638–644 CrossRefPubMed Heniford BT, Walters AL, Lincourt AE et al (2008) Comparison of generic versus specific quality-of-life scales for mesh hernia repairs. J Am Coll Surg 206(4):638–644 CrossRefPubMed
13.
Zurück zum Zitat Colavita PD, Tsirline VB, Belyansky I et al (2012) Prospective, long-term comparison of quality of life in laparoscopic versus open ventral hernia repair. Ann Surg 256(5):714–722 CrossRefPubMed Colavita PD, Tsirline VB, Belyansky I et al (2012) Prospective, long-term comparison of quality of life in laparoscopic versus open ventral hernia repair. Ann Surg 256(5):714–722 CrossRefPubMed
14.
Zurück zum Zitat Novitsky YW, Elliott HL, Orenstein SB et al (2012) Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg 204(5):709–716 CrossRefPubMed Novitsky YW, Elliott HL, Orenstein SB et al (2012) Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg 204(5):709–716 CrossRefPubMed
15.
Zurück zum Zitat Novitsky YW, Fayezizadeh M, Majumder A et al (2016) Outcomes of Posterior Component Separation With Transversus Abdominis Muscle Release and Synthetic Mesh Sublay Reinforcement. Ann Surg 264(2):226–232 CrossRefPubMed Novitsky YW, Fayezizadeh M, Majumder A et al (2016) Outcomes of Posterior Component Separation With Transversus Abdominis Muscle Release and Synthetic Mesh Sublay Reinforcement. Ann Surg 264(2):226–232 CrossRefPubMed
16.
Zurück zum Zitat Berry MF, Paisley S, Low DW et al (2007) Repair of large complex recurrent incisional hernias with retromuscular mesh and panniculectomy. Am J Surg 194(2):199–204 CrossRefPubMed Berry MF, Paisley S, Low DW et al (2007) Repair of large complex recurrent incisional hernias with retromuscular mesh and panniculectomy. Am J Surg 194(2):199–204 CrossRefPubMed
17.
Zurück zum Zitat Weltz AS, Sibia US, Zahiri HR et al (2017) Operative outcomes after open abdominal wall reconstruction with retromuscular mesh fixation using fibrin glue versus transfascial sutures. Am Surg 8:503–515 Weltz AS, Sibia US, Zahiri HR et al (2017) Operative outcomes after open abdominal wall reconstruction with retromuscular mesh fixation using fibrin glue versus transfascial sutures. Am Surg 8:503–515
18.
Zurück zum Zitat Novitsky YW, Porter JR, Rucho ZC et al (2006) Open preperitoneal retrofascial mesh repair for multiply recurrent ventral incisional hernias. J Am Coll Surg 203:283–289 CrossRefPubMed Novitsky YW, Porter JR, Rucho ZC et al (2006) Open preperitoneal retrofascial mesh repair for multiply recurrent ventral incisional hernias. J Am Coll Surg 203:283–289 CrossRefPubMed
19.
Zurück zum Zitat Giurgius M, Bendure L, Davenport DL et al (2012) The endoscopic component separation technique for hernia repair results in reduced morbidity compared to the open component separation technique. Hernia 16:47–51 CrossRefPubMed Giurgius M, Bendure L, Davenport DL et al (2012) The endoscopic component separation technique for hernia repair results in reduced morbidity compared to the open component separation technique. Hernia 16:47–51 CrossRefPubMed
20.
Zurück zum Zitat Iqbal CW, Pham TH, Joseph A et al (2007) Long-term outcome of 254 complex incisional hernia repairs using the modified Rives-Stoppa technique. World J Surg 31:2398–2404 CrossRefPubMed Iqbal CW, Pham TH, Joseph A et al (2007) Long-term outcome of 254 complex incisional hernia repairs using the modified Rives-Stoppa technique. World J Surg 31:2398–2404 CrossRefPubMed
21.
Zurück zum Zitat Hanna EM, Byrd JF, Moskowitz M et al (2014) Outcomes of a prospective multi-center trial of a second-generation composite mesh for open ventral hernia repair. Hernia 18(1):81–89 CrossRefPubMed Hanna EM, Byrd JF, Moskowitz M et al (2014) Outcomes of a prospective multi-center trial of a second-generation composite mesh for open ventral hernia repair. Hernia 18(1):81–89 CrossRefPubMed
22.
Zurück zum Zitat Vermeulen J, Alwayn I, Stassen LP (2003) Prolonged abdominal wall pain caused by transfascial sutures used in the laparoscopic repair of incisional hernia. Surg Endosc 17(9):1497 CrossRefPubMed Vermeulen J, Alwayn I, Stassen LP (2003) Prolonged abdominal wall pain caused by transfascial sutures used in the laparoscopic repair of incisional hernia. Surg Endosc 17(9):1497 CrossRefPubMed
23.
Zurück zum Zitat LeBlanc KA (2007) Laparoscopic incisional hernia repair: are transfascial sutures necessary? A review of the literature. Surg Endosc 21(4):508–513 CrossRefPubMed LeBlanc KA (2007) Laparoscopic incisional hernia repair: are transfascial sutures necessary? A review of the literature. Surg Endosc 21(4):508–513 CrossRefPubMed
24.
Zurück zum Zitat Brill JB, Turner PL (2011) Long-term outcomes with transfascial sutures versus tacks in laparoscopic ventral hernia repair: a review. Am Surg 77(4):458–465 PubMed Brill JB, Turner PL (2011) Long-term outcomes with transfascial sutures versus tacks in laparoscopic ventral hernia repair: a review. Am Surg 77(4):458–465 PubMed
Metadaten
Titel
A novel approach using the enhanced-view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair
verfasst von
Igor Belyansky
Jorge Daes
Victor Gheorghe Radu
Ramana Balasubramanian
H. Reza Zahiri
Adam S. Weltz
Udai S. Sibia
Adrian Park
Yuri Novitsky
Publikationsdatum
15.09.2017
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 3/2018
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-017-5840-2