pp 1–9 | Cite as

Precostal top-down extended totally extraperitoneal ventral hernia plasty (eTEP): simplification of a complex technical approach

  • G. KöhlerEmail author
  • R. Kaltenböck
  • R. Pfandner
  • B. Dauser
  • M. Lechner
Original Article



Retromuscular mesh augmentation is generally considered to be the ideal technique for repairing ventral hernias and can be performed laparoscopically by ‘enhanced view totally extraperitoneal plasty’ (eTEP)—a technically complex procedure that requires a high level of surgical expertise. We aimed to develop a simplified technical modification.


Thirty-one patients with ventral hernias were operated with a modified precostal, top-down eTEP approach, and prospectively recorded in our hernia registry. We describe this novel standardized precostal access and the bilateral development of both retromuscular compartments with a cylindrical dilating balloon port. Demographic-, hernia-specific-, and perioperative data were analyzed retrospectively.


Twenty-two primary and 9 incisional hernias with an average defect size of 34.5 cm2 were repaired. An average implant of 420 cm2 always completely covered diastasis recti and/or scars from previous midline laparotomies. Average procedure time was 128 min. One conversion was required due to peritoneal injury. Postoperatively there was one local infection and one patient suffered an interparietal herniation. There were no recurrences during the average 8-month follow-up period.


With technical modification of precostal access and pneumatic balloon dilation of both retro-rectus compartments, the complex procedure can be simplified through time saving and straightforward unidirectional ‘top-down’ dissection. The better overview facilitates the crossover for connecting both retro-rectus spaces. In addition, the cranial access allows the anterior- and posterior layers to be closed up to the xiphoid.


eTEP Sublay Ventral hernia Incisional hernia Stoppa/Rives 


Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

The protocol was approved by the ethics committee of the institutions.

Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  • G. Köhler
    • 1
    • 2
    • 3
    • 4
    • 5
    Email author
  • R. Kaltenböck
    • 1
  • R. Pfandner
    • 1
  • B. Dauser
    • 6
  • M. Lechner
    • 2
  1. 1.Department of General and Visceral SurgeryCongregation Hospital (Sisters of Charity)LinzAustria
  2. 2.Department of SurgeryParacelsus Medical UniversitySalzburgAustria
  3. 3.Academic Teaching Hospital of the Medical UniversityViennaAustria
  4. 4.Academic Teaching Hospital of the Medical UniversityGrazAustria
  5. 5.Academic Teaching Hospital of the Medical UniversityInnsbruckAustria
  6. 6.Department of SurgerySt. John of God HospitalViennaAustria

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