eTEP FOR A LARGE INCARCERATED PRIMARY VENTRAL HERNIA: EXPANDING THE INDICATIONS FOR eTEP TECHNIQUE TO THE EMERGENCY SETTING

Abstract Clinical case 66-year-old female patient; Medical history: BMI 34,7 kg/m², chronic smoker, diabetes mellitus type II; Diagnosed in 2022 of a large and reducible primary ventral hernia M3W2 with recti diastasis associated: 36 mm at epigastric and 68 mm at supraumbilical level, respectively. She presented at the emergency department with a 24 hours history of an umbilical painful and irreducible lump associated with nausea. Investigation Bloodtest: Leukocytes 8,8 × 109/l; prothrombin time 65%; C-reactive protein 190,85 mg/dl. Abdominal X-ray showed no abnormalities. Abdominal ultrasound showed a large umbilical sac, which contained epiplon with signs of suffering. No anaesthetic contraindication for an emergent endoscopic surgery. Therapy and Outcome An umbilical hernioplasty and recti diastasis correction was performed using the eTEP technique. Absorbable barbed suture 2–0 were used to close de defect and correct the recti diastasis. A macroporous polypropylene mesh was implanted without fixation, which covered entirely the dissected area and not just the hernia area. No drains were used. The patient had an uneventful hospital stay and was discharged at 36 hours after surgery. An umbilical subcutaneous seroma M3-type IV, according to the Morales-Conde Classification, was developed. No evidence of recurrence neither clinically nor radiologically at 6 months follow-up. Conclusion There is a lack of scientific evidence about the use of eTEP technique in the emergent treatment of complicated ventral hernia. eTEP approach to this type of hernia is a promising abdominal wall reconstruction technique. It is reproducible and safe, with short hospital stay, low morbidity and short-term effective.