LAPAROSCOPIC EXTENDED TOTALLY EXTRAPERITONEAL (e-TEP) TREATMENT OF VENTRAL HERNIAS: TIPS & TRICKS

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 some tips and tricks in the eTEP laparoscopic approach. Material and Methods Video presentation. Results In the following video, we present certain recommendations that will help you perform a laparoscopic e-TEP approach in a simpler and faster way.Performing an ultrasound of the abdominal wall prior to the start of surgery to locate the lateral border of the rectus.We have modified the position of the trocars, depending on whether we perform a supraumbilical or infraumbilical crossover, in such a way that it will allow us better ergonomics at the time of dissection and sutures.The closure of the anterior rectus sheath, from up to down, is performed with the needle holder in the left hand since it is a more ergonomic position and a more correct closure and better plication of the abdominal diastasis is performed.Measurement of the dissected space using a thread, to have a more accurate mesh of the dissected space.Positioning of the mesh before placing it, using vicryl and silk points, in such a way that they will help us to better extend it within the abdomen.Use of atraumatic fixation systems, such as fibrin glue, which, in addition to fixing the mesh, acts as a hemostatic agent.No drains. Use of an abdominal binder during the first 4 weeks after surgery. Conclusions The laparoscopic e-TEP approach is not simple, and requires skill and knowledge of the anatomy of the abdominal wall, and may initially require long times to perform a correct repair; however, applying some of the previously mentioned recommendations, surgical times can be reduced. can decrease as well as the risk of complications.