V-025 Etep-Rs: Extended Totally Extraperitoneal Rives-Stoppa Technique for Small Ventral Hernia

Abstract

Aim The aim is to describe the laparoscopic surgical technique of eTEP with 3 trocars from the upper port in a 52-year-old male patient who presented 3 small ventral hernias Material & Methods Recently, the surgical technique of ventral hernia repair, Rives-Stoppa e-TEP eventroplasty (eTEP-RS) has been introduced. First, 2 subcostal incisions are made. By introducing the dissector balloon through both retromuscular spaces up to the linea arcuata, the retromuscular space is exposed. Great care must be taken to preserve the neurovascular bundles at semilunar line. A 5mm trocar is placed on the right flank to perfom the epigastric crossover maniobre by incising the medial aspect of rigth posterior sheath. The dissection of the left retromuscular space is performed. The midline dissection is progressed to the retzius, completing the Rives retromuscular space. The hernia sacs are dissected and reduced. Finally, posterior rectus sheaths and the linea alba are sutured with 2/0 absorbable self-locking continuous barb suture and a mesh is placed in the retromuscular space. Results The patient was discharged the next postoperative day with good pain control. To date, he does not present data on hernia recurrence. Conclusions The repair of abdominal wall defects via endoscopic eTEP Rives-Stoppa with three trocars is a feasible and reproducible technique that meets the criteria of ideal open surgery and is safe for the patient. In addition, it offers advantages such as less postoperative pain, less need for analgesia, favors rapid and safe recovery, added to an excellent aesthetic result.