EXPLORING THE DOWN TO UP RIVES eTEP TECHNIQUE: MANAGING RECURRENT MIDLINE INCISIONAL HERNIA WITH PRIOR PREPERITONEAL MESH PLACEMENT

Background To demonstrate the efficacy of the "down to up" Rives eTEP technique in the surgical management of recurrent midline incisional hernias with a history of prior preperitoneal mesh placement. Methods A 76-year-old woman with a midline incisional hernia, previously repaired using preperitoneal mesh three years ago, presented with a recurrent hernia, classified as M2-3 W2 by the European Hernia Society and confirmed by computed tomography. An endoscopic abdominal wall repair with defect closure was performed. Beginning with the insertion of the Hasson trocar into the right retrorectal space, the procedure involved meticulous dissection of the suprapubic preperitoneal space and sequential placement of three suprapubic trocars. Comprehensive dissection encompassed both retrorectal spaces and the midline preperitoneal space, including sectioning of the medial edge of the posterior rectus sheath, facilitating unification of all dissected spaces. The pre-existing mesh remained integrated into the posterior sheath. Post-dissection, the posterior and the anterior sheath were closed with a barbed suture. Finally, a 30 × 15 cm polypropylene mesh was positioned in the preperitoneal space without fixation. Results The patient experienced an uneventful postoperative recovery, leading to discharge without complications on the first postoperative day. An 18-month follow-up revealed no hernia recurrence. Conclusions This intervention successfully demonstrates the application of the "down to up" Rives eTEP technique for recurrent midline incisional hernias with prior preperitoneal mesh placement. As an alternative to open surgery, this approach offers advantages, including low infection rates, reduced postoperative pain, and shorter hospital stays.