“Enhanced” view extraperitoneal (eTEP) approach for repair of ventral hernia: Our initial experience

Abstract BACKGROUND: Over the past two decades, minimally invasive techniques for ventral hernia repair have evolved significantly. Among these, the enhanced view totally extraperitoneal approach has gained popularity in recent years. This study presents our early experience with the enhanced-view totally extraperitoneal (eTEP) technique for ventral hernia repairs. MATERIALS AND METHODS: This prospective observational study was conducted from January 2022 to April 2025. A total of 72 patients who underwent eTEP repair for midline ventral hernias were included. Patient demographics, hernia characteristics, operative details, and postoperative outcomes were also recorded. The early outcomes in terms of complications, postoperative pain, recurrence, and cosmetic satisfaction were analyzed. RESULTS: eTEP was successfully performed in 68 (94.4%) of 72 patients in whom eTEP was attempted, while in four patients, it was converted to an open or hybrid procedure. Seroma was observed in 5.9% of patients at the first week and month, and in 2.9% of patients at 3 months of follow-up. The mean visual analog scale scores showed progressive improvement, and cosmetic outcomes were excellent at 3 months (mean Likert score: 4.35/5). Two patients had recurrence, while there were no cases of surgical site infection or posterior rectus sheath rupture. CONCLUSION: The eTEP approach is feasible, safe, and cost-efficient for ventral hernia repair. Careful patient selection and proper surgical techniques are associated with favorable early outcomes, minimal complications, and high patient satisfaction. However, comparative trials and further studies with long-term follow-up are required to confirm its long-term efficacy.