Surgical Endoscopy

, Volume 32, Issue 3, pp 1525–1532 | Cite as

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

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



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.


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.


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.


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.


Ventral and incisional hernia repair Abdominal wall reconstruction Retromuscular mesh placement Transversus abdominis release Enhanced-view totally extraperitoneal technique 


Financial support

No financial support was received for this study

Compliance with ethical standards


Dr. Belyansky is a consultant for Lifecell corporation, Intuitive Surgical, Covidien Medtronic, and Bard Davol. Dr. Daes is a consultant for Winner, Medtronic, and Bard. Dr. Novitsky is a consultant for Cooper Surgical, Intuitive Surgical, and Bard. Dr. Park is a consultant for Stryker. Dr’s Zahiri, Weltz, Sibia, Balasubramanian, and Radu declare that they have no relevant conflicts of interest or financial ties to disclose.

Ethical approval

All authors certify that they accept responsibility as an author and have contributed to the concept, data gathering, analysis, manuscript drafting, and give their final approval.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Igor Belyansky
    • 1
  • Jorge Daes
    • 2
    • 3
  • Victor Gheorghe Radu
    • 4
  • Ramana Balasubramanian
    • 5
  • H. Reza Zahiri
    • 6
  • Adam S. Weltz
    • 6
  • Udai S. Sibia
    • 6
  • Adrian Park
    • 6
    • 7
  • Yuri Novitsky
    • 8
  1. 1.Department of SurgeryAnne Arundel Medical CenterAnnapolisUSA
  2. 2.Department of SurgeryClinica Bautista and Clinica PortoazulBarranquillaColombia
  3. 3.Minimally Invasive Surgery DepartmentClinica PortoazulBarranquillaColombia
  4. 4.Surgical Department Life Memorial HospitalBucharestRomania
  5. 5.Department of Comprehensive Hernia SurgeryMedica Superspecialty HospitalKolkataIndia
  6. 6.Department of SurgeryAnne Arundel Medical CenterAnnapolisUSA
  7. 7.Johns Hopkins School of MedicineBaltimoreUSA
  8. 8.Department of SurgeryUniversity Hospital Cleveland Medical CenterClevelandUSA

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