eTEP RIVES-STOPPA VS. TOTAL VISCERAL SAC SEPARATION (TVS) TECHNIQUE: DIFFERENCES BETWEEN TWO MINIMALLY INVASIVE SUBLAY APPROACHES FOR MIDLINE HERNIAS

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Abstract Background Minimally invasive abdominal wall surgery is rapidly evolving, with techniques like IPOM, TAPP and TEP increasingly being used. The latter one allows for a laparoscopic retromuscular mesh placement but often requires extensive fascial dissection. In contrast, the European Hernia Society suggests an open preperitoneal repair for smaller hernias. Recently, a different laparoscopic preperitoneal approach has been described, being essential to understand the differences between both planes. Methods A 67-year-old female patient, with no comorbidities, consulted for multiple primary ventral hernias confirmed by CT scan. Another 57-year-old woman, with previous multiple pregnancies, presented with an umbilical hernia. Both with concomitant rectus diastasis. The first underwent an eTEP Rives-Stoppa, whereas the other one, a Total Visceral Sac Separation (TVS) technique; either with a down-to-up approach. Results eTEP allowed for three M2-3W1-2 hernias reduced, the retromuscular plane dissected and the defects repaired before mesh placement; operative time (OT) was 120 minutes. In the TVS technique, an M3W1 hernia was repaired following and dissecting a wide preperitoneal space. Incidental peritoneal opening was corrected with a running barbed suture and the defect closed with a trans-fascial repair; OT was 65 minutes. No immediate post-operative complications were reported. Conclusions Differences between a preperitoneal and retromuscular approach for hernia repair are highlighted. Patients with W1 hernias could benefit from a TVS approach, being less invasive, and having advantages such as reduced abdominal wall trauma, potentially faster recovery and fewer postoperative complications, making it a suitable option for these hernias.

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