The endoscopic retromuscular approach (laparoscopic and robotic)of lateral abdominal wall hernias – a retrospective analysis from a singlecentre/single surgeon over 5 years

Lateral abdominal wall hernias account for approximately 1–4% of all surgical procedures for abdominal wall repair. The treatment of primary and incisional lateral abdominal wall hernias poses a challenge due to anatomical complexity, given the muscular stratigraphy, adjacent bony structures, and nervous elements, as well as technical difficulties in approach. Currently, there is no standardised surgical technique for the treatment of lateral hernias, with multiple approaches being presented: open, minimally invasive (laparo-endoscopic or robotic), or hybrid. Textile biomaterials are used as a biocompatible interface with the human body, in the form of medical devices, implants and prosthetic systems. The use of knitted biotextiles for non-implantable items and implants has developed greatly in the new field of tissue engineering. We present a 5-year retrospective study that includes cases of primary and incisional lateral abdominal wall hernias treated laparoscopically and robotically in the Centre of Hernia Surgery, Life Memorial Hospital, from June 2016 to December 2022. The study included 24 patients with primary and incisional hernias resolved laparoscopically (eTEP-TAR, eTEP) and 5 cases resolved robotically. The majority of the cases (80.8%) of lateral hernias are incisional; 38.5% are strictly lateral hernias, with the rest having a median component. In the laparoscopic group, eTEP-TAR was performed in 21 cases, and eTEP in 3 cases. In the 5 cases of surgery performed robotically, eTEP-TAR was carried out. No cases of conversion were recorded. For the patients operated on laparoscopically: there was one incident of small bowel injury during adhesiolysis, which was resolved during the same surgical session (with laparoscopic suture). No complications were reported in the group of patients operated on robotically. The average postoperative hospitalisation time was 39 hours. The average follow-up period was 4 years and 6 months, with no complications or recurrences. The eTEP-TAR technique for repairing lateral hernia cases (incisional and primary) is difficult and complex; however, the results are very good if performed correctly, whether laparoscopically or robotically, as demonstrated by the reduced hospital stay, low level of postoperative pain, and rapid recovery of the patients.