Enhanced view totally extraperitoneal (eTEP) repair for ventral hernia: A prospective analysis of peri-operative outcomes, functional recovery, and cost effectiveness

Abstract Introduction: Minimally invasive ventral hernia repair has traditionally been performed using intraperitoneal onlay mesh (IPOM). Although effective, IPOM places mesh within the peritoneal cavity, with potential risks related to adhesions and mesh–bowel interaction. Enhanced-view totally extraperitoneal (eTEP) repair recreates the retromuscular (Rives–Stoppa) plane using a laparoscopic approach and may reduce these concerns. Patients and Methods: A prospective, observational study was conducted on n = 24 adult patients undergoing eTEP retrorectus ventral hernia repair. Perioperative outcomes, post-operative pain (Visual Analogue Scale), complications, quality of life (Carolinas Comfort Scale; HerQLes) and abdominal wall function (double-leg lowering and trunk-raising tests) were assessed at 7 days, 1 month and 3 months. Results: The mean age was 45.6 ± 13.7 years; 54.2% were women. Mean operative time was 167.0 ± 28.7 min; no intraoperative visceral or vascular injury occurred. Surgical-site infection and seroma occurred in one patient each (4.2%) at 7 days and resolved by 1 month. Pain peaked in the early post-operative period and declined significantly over the follow-up (repeated-measures analysis of variance P < 0.001). Both CCS and HerQLes scores improved significantly at 1 and 3 months ( P < 0.001), with parallel improvement in abdominal wall function tests ( P < 0.001). Conclusion: In this early experience, eTEP retrorectus repair was feasible and safe with low early morbidity, significant improvement in patient-reported outcomes and improved abdominal wall function over 3 months. Larger comparative studies with longer follow-up are warranted.