EVOLUTION OF THE eTEP TECHNIQUE FOR VENTRAL HERNIA REPAIR: SIX-YEAR SINGLE-SURGEON EXPERIENCE WITH TECHNICAL ADVANCEMENTS AND ADAPTATIONS

Abstract Objective The aim of this study was to assess the learning curve and the implementation of tools for the correction of ventral hernias using the extended totally extraperitoneal (eTEP) approach. Materials and Methods All patients underwent eTEP ventral hernia repair performed by one surgeon. A prospective multicenter study involving patients from General Hospital of Villalba, Jiménez Díaz Foundation, and La Paz Hospital in Madrid was conducted from May 2018 to January 2024. Results Over the 6-year period, 216 patients (133 midline and 83 laterals) were operated on. There was an increased percentage of incisional and recurrent hernias compared to primary hernias, along with an observed rise in case complexity and defect size, with no significant increase in surgical time or complications. Over the technical evolution in the last 6 years, a decreasing trend in the utilization of posterior component separation with transversus abdominis release (TAR) for midline defect closure was noted, despite the increased complexity and hernia size. This shift was attributed to the use of peritoneal flap instead of TAR for closing the posterior plane in extensive defects, as well as the use of BOTOX and fascial traction for hernia defect closure. Conclusions The results demonstrate a significant evolution in the eTEP technique for treating incisional hernias, addressing larger and more complex hernias over time. Furthermore, the decreasing use of TAR for both posterior and anterior closure, in favor of adjuncts such as BOTOX, peritoneal flap, and fascial traction, facilitated a surgical downstaging and led to low complication rates.