LAPAROSCOPIC eTEP APPROACH TO VENTRAL HERNIAS: SHORT-TERM OUTCOMES

Abstract Aim Ventral hernias are a pathology with a high incidence within general surgery. Repair techniques have been evolving, and the minimally invasive approach to this type of pathology is currently on the rise due to the advantages offered by the minimally invasive surgery (laparoscopic or robotic): less postoperative pain, SSI, seromas, length of stay (LOS) and faster return to routine daily activities. We present our series of patients with ventral hernias treated by laparoscopic eTEP approach. Material and Methods Prospective study where we analyzed our database of patients with ventral hernias (primary and secondary) undergoing abdominal wall surgery using laparoscopic eTEP approach, during the period August-2021 to December-2023. We present our short-term outcomes. Results A total of 65 patients underwent laparoscopic eTEP surgery (men: 54.8%, age: 64 (RIQ: 43–73years)). LOS: 1.48 ± 0.62 days. Pathological history: diabetes mellitus (19.4%), arterial hypertension (45.2%), dyslipidemia (51.6%), smoking (25.8%), alcohol consumption (13.3%), cardiovascular disease (12.9%). ASA Classification: I (32.3%), II (45.2%), III (22.6%). BMI: 30.6 ± 4.68 kg/m2. Overweight: 11 (35.5%) and obesity: 17 (54.8%). Primary hernias: 26.7% and incisional hernias: 61.3%. Location: midline: 87%, lateral: 13%, supraumbilical: 58.1%, umbilical: 87.1% and infraumbilical: 25.8%. Hernia width (EHS classification): W1:12.9%, W2:80.6% and W3:6.5%, transverse hernia diameter: 6.5 ± 2.1 cm, hernia length size: 6.1 ± 4.4 cm. Associated with diastasis:77.4%, diastasis width: 4.9 ± 1.7 cm. Associated with inguinal hernia:19.4%. Type of laparoscopic surgical technique performed: Rives-Stoppa: 77.4%, unilateral TAR: 16.1%, bilateral TAR: 6.5%. Number of trocars used by procedure: 4(RIQ:4-5). Preoperative botulinum toxin: 22.6%. Posterior sheath closure: 74.2%. Mesh fixation type: Glutack 16.1%, Tisseel 61.3%, no fixation 22.6%. Mesh type used: Low density wide-pore polypropylene 35.5%, PVDF-Mesh 58.1%, PVDF-IPOM mesh 6.5%. Mesh size: width 18(RIQ:16–22 cm) and length 28(RIQ:25–30 cm). Drainage: 4,8%. Surgical time: 165(RIQ:120–185 min). Global and serious complications (CD≥III): 12.9% and 1.6%, Re-IQ due to incarcerated hernia due to posterior sheath dehiscence: 1.6%. No intraoperative complications. Clinical seroma: 9.7% and ultrasound seroma: 41.6% that resolved completely spontaneously during the first and second postoperative months. No cases of hematoma or surgical wound infection. Until the current follow-up we have not had any recurrence. Conclusions The laparoscopic eTEP approach of ventral hernias has a low rate of global complications, despite being our first cases performed. It also has low rates of postoperative pain and shorter LOS. We can conclude that in our Hospital the laparoscopic eTEP approach is a safe, efficient and effective technique.