Challenging recurrence after eTEP RS: Open onlay mesh repair as a last resort? A case report

Hernias present a significant surgical challenge, with the extended totally extraperitoneal (eTEP) approach, modified with the Rives–Stoppa (RS) technique, emerging as a preferred minimally invasive strategy for incisional hernia repair. This technique creates a retrorectus space without breaching the peritoneal cavity, allowing laparoscopic defect closure and extensive mesh placement. Despite its advantages, including lower recurrence rates and reduced morbidity, recurrences have been reported. We present a case of a 52-year-old female with a recurrent ventral hernia following eTEP RS repair, managed with open onlay meshplasty. Contributory factors such as obesity, surgical technique, and mesh coverage were considered. Minimally invasive procedures like eTEP RS or endoscopic mini or less open sublay or intraperitoneal onlay mesh remain the gold standard for ventral hernia repair, and recurrence management requires a measured approach. A patient-centric approach, thorough evaluation, and optimization of surgical techniques are essential to minimize recurrence. This case highlights the need for further studies to establish best practices for recurrent hernias post-eTEP RS.