RESUMO
OBJECTIVE: Treatment of large recurrent abdominal wall hernias remains a surgical challenge. The enhanced-view totally extraperitoneal (eTEP) approach is an emerging technique used to treat hernias with minimally invasive procedure. This article illustrates a step-by-step eTEP approach, used in a complex recurrent hernia repair. PATIENTS AND METHODS: A 56-years-old male had a previous epigastric hernia repair with an intraperitoneal onlay mesh (IPOM) technique in 2018. Six months later, he presented a recurrent epigastric protrusion and a new painful ombilical hernia, objectified on the CT-scan. RESULTS: Four suprapubic trocars were used to dissect the preperitoneal space below the arcuate line and the retromuscular spaces on both sides. On the mid-line, posterior fascia was divided and both hernia sacs were fully dissected. Both anterior and posterior sheats were closed with self-locking non-absorbable threads before placing a Polypropylene self-gripping mesh. The follow-up was uneventful, and the patient was discharged on day 2. CONCLUSIONS: This case report illustrates that eTEP technique can be used safely and effectively to treat complex recurrent ventral hernias even with a mesh already in place. The potential advantages of the eTEP procedure are multiple, such as improving mobility and esthetic results, reducing pain and shorting hospital length of stay.
