Surgical Management of W3 Incisional Hernias: Evaluating the Success of Etep Approach

Abstract Aim Treatment of incisional hernias using the extended totally extraperitoneal (eTEP) approach presents significant technical demands. Mostly eTEP is used for W1 and W2 defects due to the challenges posed by larger defects. This study evaluates outcomes applying eTEP for incisional hernias classified as W3 according to the European Hernia Society (EHS). Materials and Methods This prospective observational multicenter study included patients with incisional hernias larger than 10 cm in width, conducted at Fundación Jiménez Díaz and La Paz hospitals in Madrid from September 2019 to January 2024. Surgical intervention was performed through the eTEP approach. Preoperative, intraoperative, and postoperative data were collected. Results 16 patients were included (7 males and 9 females). The American Society of Anesthesiologists (ASA) classification yielded 13 (81.3%) as ASA-III. The median age was 76 years (64–87), and the median body mass index was 30 (21–40). Seven patients had midline defects and 9 lateral defects. The median width of the defect on computed tomography (CT) was 117 cm (18–176). Botox treatment was administered to 43.8% of the patients. Surgical duration had a median of 171 minutes (92–240), with 7 patients requiring transversus abdominis release and 3 patients need endoscopic fascial traction. Complications were observed in 25% of patients, with no reported recurrences during a median follow-up period of 12 months (6–52). Conclusions The eTEP technique demonstrates successful application in selected W3 incisional hernias with low conversion rates, recurrence, and complication rates. However, the use of adjuncts before and during surgery is often necessary in these cases.