abdominal wall hernia\where do we stand now

Minimal invasive surgery is in its decade, more and more surgeries are done in this manner, and we have reached the point where almost all abdominal surgeries can be performed with minimal invasive techniques. And yet abdominal wall hernia represents a problem for the surgeon and patients. In the last decade we have seen big change in the perception and understanding what is abdominal wall in anatomical layers and its dynamics. Among all the techniques their eis one that I prefer. The eTEP. The eTEP technique is closest to ideal because the abdominal cavity is not entered , is lessening the risk of visceral lesions and trocar site hernias, allows local or regional anesthesia, gives unsurpassed views of inguinal region and hernias. It reproduces the technique of Rives – Stoppa and in favor of this technique is that it is modified based on the normal anatomy of the abdominal wall and depending of the extension of the dissection and the location of the hernia. The eTEP technique is based on the anatomical principle that the extraperitoneal space can be reached from almost anywhere in the anterior abdominal wall. It provides the most of the benefits for the patients but also requires great surgical skill and understanding of the anatomy of the anterior abdominal wall.