PERITONEAL FLAP CREATION FOR INCISIONAL HERNIA REPAIR VIA eTEP

Abstract Background Peritoneal flaps assist in achieving abdominal wall closure, eliminating the need for mesh bridging and component separation techniques such as the endoscopic transverse abdominis release (eTAR). While maintaining the same concept as the open approach, in eTEP repair, the flap remains anchored to the preperitoneum and posterior rectus sheath (PRS) through its most distal dissection angle rather than its laterals. Aim To describe the peritoneal flap creation for incisional hernia repair via eTEP. Materials and Methods During hernia dissection via eTEP, we create a flap anchored to the distal angle of our midline preperitoneal dissection, releasing it from the PRS along both lateral edges if required. Following a complete retromuscular dissection, we close the PRS commencing from the most distal angle where the flap remains anchored. Subsequently, we close each lateral aspect of the peritoneal and PRS defect towards the proximal angle while incorporating the flap. Results We present 39 patients with midline incisional hernia out of a total of 62 hernia repairs via eTEP. Twenty-eight percent of cases were recurrent, and 30,9% were classified M3. The median width of the defects was 70 mm in both groups, with a maximum of 104 mm for the non-eTAR group and 143 mm for eTAR. Only 17,9% required TAR. We observed a 26,3% complication rate (4 cases) within the eTAR group while no complications in the non eTAR (p = 0,617). Complications included seroma and hematoma. Conclusions Peritoneal flap is a helpful technique for incisional hernia repair via eTEP, allowing midline closure without the need of eTAR.