Surgery · 2026
Preperitoneal enhanced-view totally extraperitoneal (PeTEP) technique in midline and lateral incisional hernia repair: Early multicenter outcomes.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Munoz-Rodriguez Joaquín M, Román García de León Laura, Robin Valle De Lersundi Álvaro, Blazquez-Hernando Luis A, Medina Pedrique Manuel, Fidalgo Martínez Celia, De Luca Marcello, Lucena de la Poza José Luis, Garcia-Urena Miguel A, Lopez-Monclus Javier
Аннотация
BACKGROUND: Minimally invasive options for incisional hernia repair have expanded, yet data on preperitoneal enhanced-view totally extraperitoneal approaches for incisional hernias are limited. We aimed to evaluate safety, feasibility, and early outcomes of the preperitoneal enhanced-view totally extraperitoneal approach via cranial, caudal, and midline access in midline and lateral incisional hernias.
METHODS: We performed a multicenter retrospective cohort study across 2 university hospitals (January 2024-June 2025). Patients with midline or lateral incisional hernias undergoing a preperitoneal enhanced-view totally extraperitoneal approach were included; primary hernias and loss-of-domain cases were excluded. Perioperative management was standardized. The primary end point was recurrence; secondary end points included surgical site occurrences, surgical site occurrences requiring procedural intervention, mesh infection, bulging, chronic pain, operative time, and length of stay.
RESULTS: We analyzed 60 incisional hernia repairs (58.3% men; age 65.1 ± 12.2 years; body mass index 28.7 ± 4.2 kg/m2; obesity 35%). Defects were midline in 81.7% and lateral in 18.3%; most were European Hernia Society W2 classification. Access was cranial in 76.7%, midline 13.3%, and caudal in 10.0%. Three procedures required intraoperative conversion to enhanced-view totally extraperitoneal approach due to peritoneal fragility; no conversions to open surgery occurred. Fascial closure was achieved in all cases; a tailored preperitoneal mesh (mean area 544.6 ± 272 cm2) was placed without fixation. Mean operative time was 163 ± 66 minutes; length of stay was 1.28 ± 0.7 days. Surgical site occurrence rate was 6.6% (2 superficial hematomas, 2 asymptomatic seromas), with no surgical site infections or surgical site occurrences requiring procedural interventions. At 8.12 ± 3.92 months' follow-up, there were no recurrences, mesh infections, chronic seromas, or chronic pain.
CONCLUSIONS: The preperitoneal enhanced-view totally extraperitoneal approach appears to be a feasible and safe minimally invasive option for midline and lateral incisional hernia repair, enabling broad anatomic applicability with low short-term morbidity and no early recurrences. Prospective studies with long-term follow-up are needed to validate its long-term efficacy.
METHODS: We performed a multicenter retrospective cohort study across 2 university hospitals (January 2024-June 2025). Patients with midline or lateral incisional hernias undergoing a preperitoneal enhanced-view totally extraperitoneal approach were included; primary hernias and loss-of-domain cases were excluded. Perioperative management was standardized. The primary end point was recurrence; secondary end points included surgical site occurrences, surgical site occurrences requiring procedural intervention, mesh infection, bulging, chronic pain, operative time, and length of stay.
RESULTS: We analyzed 60 incisional hernia repairs (58.3% men; age 65.1 ± 12.2 years; body mass index 28.7 ± 4.2 kg/m2; obesity 35%). Defects were midline in 81.7% and lateral in 18.3%; most were European Hernia Society W2 classification. Access was cranial in 76.7%, midline 13.3%, and caudal in 10.0%. Three procedures required intraoperative conversion to enhanced-view totally extraperitoneal approach due to peritoneal fragility; no conversions to open surgery occurred. Fascial closure was achieved in all cases; a tailored preperitoneal mesh (mean area 544.6 ± 272 cm2) was placed without fixation. Mean operative time was 163 ± 66 minutes; length of stay was 1.28 ± 0.7 days. Surgical site occurrence rate was 6.6% (2 superficial hematomas, 2 asymptomatic seromas), with no surgical site infections or surgical site occurrences requiring procedural interventions. At 8.12 ± 3.92 months' follow-up, there were no recurrences, mesh infections, chronic seromas, or chronic pain.
CONCLUSIONS: The preperitoneal enhanced-view totally extraperitoneal approach appears to be a feasible and safe minimally invasive option for midline and lateral incisional hernia repair, enabling broad anatomic applicability with low short-term morbidity and no early recurrences. Prospective studies with long-term follow-up are needed to validate its long-term efficacy.