“Modified Three-Port Technique” of Extended Totally Extra Peritoneal-Rives Stoppa (eTEP-RS) Repair for Midline Ventral Hernias

Totally extra Peritoneal-Rives Stoppa (eTEP-RS) is one of the minimal access techniques of retro muscular mesh repair for ventral hernias. While performing this procedure, there has been significant variations among surgeons in patient positioning, position of monitor, site and number of ports placed. It has been also observed that there is also need to shift the camera and working ports as well as change from 10- to 5-mm telescope and vice versa frequently during the procedure. The aim of this study is to develop a simplified technical modification with an attempt to standardise the eTEP-RS procedure. From January 2022 to July 2022, 32 patients underwent ETEP-RS for midline ventral hernias by this modified three-port technique. Out of 32 patients who underwent eTEP-RS for midline ventral hernias, 3 patients underwent surgery for associated inguinal hernia and 3 patients required transverse abdominis release (TAR). The mean operating time was 92.3 min with range from 80 to 130 min. It was observed that with increase in experience, the operative time was reduced. Mean defect width was 5.8 cm, and defect area was 37.01 cm². We had used 20 cm × 25 cm mesh for most of our patients. There was no recurrence or major complication. Based on our initial experiences, we present a detailed description of the surgical technique itself, as well as the essential nuances to enable evaluation of the technique and standardisation. Modified three-port ETEP-RS technique is safe, feasible, and reproducible for midline ventral hernias. This technique can be combined with right-sided TAR and inguinal hernias. It can be adapted in peripheries where facilities and resources are limited.