RIVES eTEP PROCEDURE FOLLOWING LAPAROSCOPIC REDUCTION FOR CHRONIC INCARCERATED INCISIONAL HERNIA MANAGEMENT

Background We aim to showcase the effectiveness of the Rives eTEP technique in surgically managing chronically incarcerated midline incisional hernias following laparoscopic reduction of herniated contents. Methods A 69-year-old woman, with predisposing factors for surgical wound infection and hernia recurrence (obesity, smoking, diabetes mellitus), presented with a midline incisional hernia, previously managed conservatively with manual reduction during multiple emergency room visits. Preoperative optimization was conducted for a hernia classified as M2-3 W2 by the European Hernia Society. On the scheduled surgery day, the patient presented with a hernia incarcerated for several days. Exploratory laparoscopy was performed to reduce hernia contents (omentum), followed by trocar reorientation to access the retromuscular plane for endoscopic abdominal wall repair with defect closure. After laparoscopic intraperitoneal reduction, trocar insertion in retrorectal space cause a tear in the posterior rectus sheath and create a pneumoperitoneum. This prompted a shift in dissection initiation to the right retrorectal space, achieving extensive dissection before performing the crossover to the left side to counteract pneumoperitoneum effects. Closure of both posterior and anterior layer was accomplished using barbed sutures, followed by placement of a 30 × 18 cm polypropylene mesh in the retromuscular space without fixation. Results The patient experienced an uncomplicated postoperative recovery, with discharge on the second postoperative day. A 12-month follow-up revealed no hernia recurrence. Conclusions Exploratory laparoscopy for hernia reduction enables avoidance of inadvertent intestinal injuries and allows for adaptation to the retromuscular plane via eTEP. Extensive retrorectal space dissection is advisable to prevent undesired pneumoperitoneum consequences.