SpringerLink
Log in

“Fully endoscopic preperitoneal ascending suprapubic approach for minimally invasive repair of anterior and lateral abdominal wall hernias”

  • Original Article
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Purpose

The aim of this work is to describe the rational, feasibility and clinical and Quality-of-life improvement results of a fully endoscopic preperitoneal repair for midline and lateral abdominal wall hernias, starting from the space of Retzius in a “bottom-to-up” approach.

Methods

An observational prospective data-collected and quality of life study is performed in selected patients with less than 10 cm. in diameter midline and lateral abdominal wall hernias. A suprapubic upward e-TEP technique from a previously dissected Retzius space, is performed in all cases. The surgical goal is to perform a total free-tension abdominal wall reconstruction followed by a prosthetic hernioplasty. Clinical Data is classified in preoperative, intraoperative, and postoperative variables, including a quality-of-life clinical evaluation based on an improvement of HerQLes score.

Results

A total of 30 patients underwent this approach from September 2017 to October 2022 in a single-surgeon practice. A total restoration of the previous abdominal wall anatomy and a prosthetic repair were achieved in all cases. The mean operative time was 142.53 min, with a significant shorter time in lateral hernias approach. Minor complications (Clavien-Dindo I) were collected in 10% of the patients. Major complications (Clavien-Dindo IIIb) occurred in 6.66% of the patients. The mean pain at discharge was 1.83 VAS, with a significant lower pain in M-eTEP approach for lateral hernias. The mean hospital stay was 42.4 h. No seroma, hematoma, chronic pain, or recurrence was observed in the mean follow-up (20.33 months). A clinical and quality of life improvement was found in 92.9% of the patients, measured by a minimal clinical important difference (MCID) between preoperative and postoperative HerQLes score.

Conclusion

Despite being a technically demanding approach, the results obtained by this approach are compatible in safety and feasibility with other minimally invasive preperitoneal hernia repair techniques, in addition to obtaining a significant improvement in the quality of life of patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data avalilability

The data that support the findings of this study are available on request from the corresponding author.

References

  1. Miserez M, Penninckx F (2002) Endoscopic totally preperitoneal ventral hernia repair. Surg Endosc 16(8):1207–1213. https://doi.org/10.1007/s00464-001-9198-z

    Article  CAS  PubMed  Google Scholar 

  2. Belyansky I, Daes J, Radu VG, Balasubramanian R, Reza Zahiri H, Weltz AS, Sibia US, Park A, Novitsky Y (2018) A novel approach using the enhanced view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair. Surg Endosc 32(3):1525–1532. https://doi.org/10.1007/s00464-017-5840-2

    Article  PubMed  Google Scholar 

  3. Schwarz J, Reinpold W, Bittner R (2017) Endoscopic mini/less open sublay technique (EMILOS)-a new technique for ventral hernia repair. Langenbecks Arch Surg 402(1):173–180. https://doi.org/10.1007/s00423-016-1522-0

    Article  CAS  PubMed  Google Scholar 

  4. Capitano S (2018) Totally extraperitoneal approach for ventral hernia. Surg Endosc 32(3):1585. https://doi.org/10.1007/s00464-017-5761-0

    Article  PubMed  Google Scholar 

  5. Robin-Lersundi A, Blazquez Hernando L, López-Monclús J, Cruz Cidoncha A, San Miguel Méndez C, Jimenez Cubedo E, García-Ureña MA (2018) How we do it: down to up posterior components separation. Langenbecks Arch Surg 403(4):539–546. https://doi.org/10.1007/s00423-018-1655-4

    Article  PubMed  Google Scholar 

  6. Extracorporeal, Intracorporeal Versus (2019) 27th international congress of the european association for endoscopic surgery (EAES) Sevilla, Spain, 12–15 June 2019. Surg Endosc 33(Suppl 2):485–781. https://doi.org/10.1007/s00464-019-07109-x

    Article  Google Scholar 

  7. Saklad M (1941) Grading of patients for surgical procedure. Anesthesiology 2:281–284. https://doi.org/10.1097/00000542-194105000-00004

    Article  Google Scholar 

  8. Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, Dietz UA, Eker HH, El Nakadi I, Hauters P, Hidalgo Pascual M, Hoeferlin A, Klinge U, Montgomery A, Simmermacher RK, Simons MP, Smietański M, Sommeling C, Tollens T, Vierendeels T, Kingsnorth A (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13(4):407–714. https://doi.org/10.1007/s10029-009-0518-x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Tanaka EY, Yoo JH, Rodrigues AJ Jr, Utiyama EM, Birolini D, Rasslan S (2010) A computerized tomography scan method for calculating the hernia sac and abdominal cavity volume in complex large incisional hernia with loss of domain. Hernia 14(1):63–69. https://doi.org/10.1007/s10029-009-0560-8

    Article  CAS  PubMed  Google Scholar 

  10. Krpata DM, Schmotzer BJ, Flocke S, ** J, Blatnik JA, Ermlich B, Novitsky YW, Rosen MJ (2012) Design and initial implementation of HerQLes: a hernia-related quality-of-life survey to assess abdominal wall function. J Am Coll Surg 215(5):635–642. https://doi.org/10.1016/j.jamcollsurg.2012.06.412

    Article  PubMed  Google Scholar 

  11. Renshaw SM, Gupta A, Poulose BK (2022) Establishing the minimal clinically important difference for the hernia-related quality of life survey (HerQLes). Am J Surg 223(2):245–249. https://doi.org/10.1016/j.amjsurg.2021.06.018

    Article  PubMed  Google Scholar 

  12. Sinha A, Jayaraman L, Punhani D, Chowbey P (2018) Transversus abdominis plane block for pain relief in patients undergoing in endoscopic repair of abdominal wall hernia: a comparative, randomised double-blind prospective study. J Minim Access Surg. 14(3):197–201. https://doi.org/10.4103/jmas.jmas_138_17

    Article  PubMed  PubMed Central  Google Scholar 

  13. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ferrán Aranaz M (1996) SPSS para windows programación y análisis estadístico. Mc Graw Hill, New York

    Google Scholar 

  15. Radu VG, Lica M (2019) The endoscopic retromuscular repair of ventral hernia: the eTEP technique and early results. Hernia 23(5):945–955. https://doi.org/10.1007/s10029-019-01931-x

    Article  CAS  PubMed  Google Scholar 

  16. Prakhar G, Parthasarathi R, Cumar B, Subbaiah R, Nalankilli VP, Praveen Raj P, Palanivelu C (2021) Extended view: totally extra peritoneal (e-TEP) approach for ventral and incisional hernia-early results from a single center. Surg Endosc 35(5):2005–2013. https://doi.org/10.1007/s00464-020-07595-4

    Article  PubMed  Google Scholar 

  17. Yeow M, Wijerathne S, Lomanto D (2022) Intraperitoneal versus extraperitoneal mesh in minimally invasive ventral hernia repair: a systematic review and meta-analysis. Hernia 26(2):533–541. https://doi.org/10.1007/s10029-021-02530-5

    Article  CAS  PubMed  Google Scholar 

  18. Martin-Del-Campo LA, Miller HJ, Elliott HL, Novitsky YW (2018) Laparoscopic ventral hernia repair with and without defect closure: comparative analysis of a single-institution experience with 783 patients. Hernia 22(6):1061–1065. https://doi.org/10.1007/s10029-018-1812-2

    Article  PubMed  Google Scholar 

  19. Rives J, Pire JC, Flament JB, Convers G (1977) [Treatment of large eventrations (apropos of 133 cases)]. Minerva Chir 32(11):749–756

    CAS  PubMed  Google Scholar 

  20. Sosin M, Nahabedian MY, Bhanot P (2018) The perfect plane: a systematic review of mesh location and outcomes, update 2018. Plast Reconstr Surg 142(3S):107S-116S. https://doi.org/10.1097/prs.0000000000004864

    Article  CAS  PubMed  Google Scholar 

  21. Juárez Muas DM (2019) Preaponeurotic endoscopic repair (REPA) of diastasis recti associated or not to midline hernias. Surg Endosc 33(6):1777–1782. https://doi.org/10.1007/s00464-018-6450-3

    Article  PubMed  Google Scholar 

  22. Ferzli GS, Massad A, Albert P (2019) Extraperitoneal endoscopic inguinal hernia repair. J Laparoendosc Surg 2(6):281–286. https://doi.org/10.1089/lps.1992.2.281

    Article  Google Scholar 

  23. Pini R, Di Giuseppe M, Toti JMA, Mongelli F, Marcantonio M, Spampatti S, La Regina D (2021) Robot-assisted treatment of epigastric hernias with a suprapubic approach. Surg Laparosc Endosc Percutan Tech 31(5):584–587. https://doi.org/10.1097/sle.0000000000000941

    Article  PubMed  Google Scholar 

  24. Muysoms F, Van Cleven S, Pletinckx P, Ballecer C, Ramaswamy A (2018) Robotic transabdominal retromuscular umbilical prosthetic hernia repair (TARUP): observational study on the operative time during the learning curve. Hernia 22(6):1101–1111. https://doi.org/10.1007/s10029-018-1825-x

    Article  CAS  PubMed  Google Scholar 

  25. Hillebrandt KH, Moosburner S, Winter A, Nevermann N, Raschzok N, Malinka T, Sauer IM, Schmelzle M, Pratschke J, Chopra S (2022) The influence of the COVID-19 pandemic on surgical therapy and care: a cross-sectional study. BMC Surg 22(1):259. https://doi.org/10.1186/s12893-022-01708-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This research has not received specific support from public sector agencies, the commercial sector, or non-profit entities.

Author information

Author notes

  1. Federico del Castillo-Diez

    Present address: General and Digestive Surgery Department, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain

Authors and Affiliations

  1. General and Digestive Surgery Department, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain

    I. Pascual-Migueláñez & J. Díaz-Domínguez

  2. Urology Department, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain

    A. Leivar-Tamayo

  3. General and Digestive Surgery Department, Universitario Infanta Sofía, Universidad Europea de Madrid, Madrid, Spain

    L. García-Sancho Téllez

Authors
  1. Federico del Castillo-Diez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. I. Pascual-Migueláñez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Leivar-Tamayo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L. García-Sancho Téllez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Díaz-Domínguez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Federico del Castillo-Diez.

Ethics declarations

Conflict of interests

All authors declare that there is no financial or personal relationship with other people or organizations that could have inappropriately influenced this work.

Hospital ethical committee

This study was fully approved by the Hospital Ethics Committee (Internal Code: 2023.847, Code HULP: PI-5961).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (MP4 382912 KB)

Supplementary file2 (MP4 377026 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

del Castillo-Diez, F., Pascual-Migueláñez, I., Leivar-Tamayo, A. et al. “Fully endoscopic preperitoneal ascending suprapubic approach for minimally invasive repair of anterior and lateral abdominal wall hernias”. Hernia (2024). https://doi.org/10.1007/s10029-024-03070-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10029-024-03070-4

Keywords

Search

Navigation