Abdominal Wall Repair Research Articles

Mechanical characterization and modeling of knitted textile implants with permanent set

Textile-based implant (mesh) treatment is considered as a standard of care for abdominal wall hernia repair. Computational models and simulations have appeared as one of the most promising approach to investigate biomechanics related to hernia repair and to improve clinical outcomes. This paper presents a novel anisotropic hypo-elastoplastic constitutive model specifically established for surgical knitted textile implants. The major mechanical characteristics of these materials such as anisotropy and permanent set have been reproduced. For the first time ever, we report an extensive mechanical characterization of one of these meshes, including cyclic uniaxial tension, planar equibiaxial tension and plunger type testing. These tests highlight the complex mechanical behavior with strong nonlinearity, anisotropy and permanent set. The novel anisotropic hypo-elasto-plastic constitutive model has been identified based on the tensile experiments and validated successfully against the data of the plunger experiment. In the future, implementation of this characterization and modeling approach to additional surgical knitted textiles should be the direction to follow in order to develop clinical decision support software for abdominal wall repair.

Ventral hernia repair in bariatric patients.

Morbid Obesity is increasing worldwide at fast pace with associated co-morbidities also on the rise. Considering that Obesity is one of the main risk factor for developing a Ventral Hernia this will results that in the future we will experience a rise in those hernia in patients undergoing any abdominal surgery. There is no clarity on the best timing and choice for procedures. We are well aware also on the difficulties in hernia repair surgery and the relative outcome so adding obesity as co-factors amplify the challenges. In fact, today both general surgeons with expertise in abdominal wall repair and bariatric surgeons are faced with a new dilemma: the obese patient with an abdominal wall hernia. This article will briefly review the impact of obesity on the natural history of hernia, its associated complication, management strategies and outcome.

Multiscale mechanical characterization of knitted abdominal wall repair meshes

Abdominal wall hernia (AWH) is a protrusion of the abdominal cavity contents through a defect in the abdominal wall. AWH repair is one of the most common surgeries worldwide and the use of mesh has...

Hybrid versus open retromuscular abdominal wall repair: early outcomes.

The hybrid approach to abdominal wall reconstruction (AWR) for abdominal wall hernias combines minimally invasive posterior component separation and retromuscular dissection with open fascial closure and mesh implantation. This combination may enhance patient outcomes and recovery compared to the open approach alone. The purpose of this study is to evaluate the operative outcomes of hybrid vs. open abdominal wall reconstruction. A retrospective review was conducted to compare patients who underwent open versus hybrid AWR between September 2015 and August of 2018 at Anne Arundel Medical Center. Patient demographics and perioperative data were collected and analyzed using univariate analysis. Sixty-five patients were included in the final analysis: 10 in the hybrid and 55 in the open groups. Mean age was higher in the hybrid vs. open group (65.1 vs. 56.2years, p < 0.05). The hybrid and open groups were statistically similar (p > 0.05) in gender distribution, mean BMI, and ASA score. Intraoperative comparison found hybrid patients parallel to open patients (p > 0.05) in mean operative time (294.5 vs. 267.5min), defect size (14.4 vs. 13.6cm), mesh area, and drain placement. The mean total hospital cost was lower in the hybrid group compared to the open group ($16,426 vs. $19,054, p = 0.43). The hybrid group had a shorter length of stay (5.3 vs. 3.6days, p = 0.03) after surgery and was followed for a similar length of time (12.3 vs. 12.6months, p = 0.91). The hybrid group showed a lower trend of seroma, hematoma, wound infection, ileus, and readmission rates after surgery. A review of patient outcomes after hybrid AWR highlights a trend towards shorter length of stay, lower hospital cost, and fewer complications without significant addition to operative time. Long-term studies on a larger number of patients are definitively needed to characterize the comprehensive benefits of this approach.

Successful management of the open abdomen with hydrocolloid dressing in a resource-constrained setting.

To evaluate and detail the management of a difficult, long-term, open abdomen in a resource constraint setting with the use of Hydrocolloid dressing. An observational retrospective study was conducted at a single level-1 trauma center. Over a 5-year period, all the open abdomen patients were evaluated and the cohorts who were treated with Hydrocolloid dressings were described in detail from their admission to their discharge. During this period, there were 147 open abdomens. 7.5% (11) patients required long-term open abdomen management, in which Hydrocolloid dressing was utilized. Of this group, there were no entero/colonic-atmospheric fistulas, and there was either de-novo complete skin coverage, successful skin graft placement, or definitive abdominal wall repair in all the patients. De-novo complete skin coverage took an average of 7.4months. All the patients were discharged home after an average of 107days hospitalized. Despite not being an optimal management of an open abdomen, there are always a small group of these patients who lose abdominal domain, are critically ill or injured, and have prolonged hospitalization with an open abdomen. In this cohort, and especially in resource constraint settings, Hydrocolloid dressing is a cost-efficient, simple, and effective method to treat the 'long-term' open abdomens.

Abdominal wall reconstruction with biosynthetic absorbable mesh after infected prosthesis explantation: single stage is better than two-stage approach of chronic mesh infection.

To assess the efficacy of surgical management of chronic mesh infection (CMI) after abdominal wall hernia repair (AWHR) in single-stage approach (complete removal of infected prosthesis and simultaneous replacement with poly-4-hydroxybutyrate mesh or BAM group), comparing results with two-stage treatment (complete mesh excision and abdominal wall repair with synthetic mesh after several months or SPM group). Retrospective comparative study of all patients who underwent surgery for CMI between January 2006 and January 2019 at a tertiary center. We compared results in terms of epidemiological data, hernia and prosthesis characteristics, surgical and postoperative variables of both two groups. Over the 13-year study period, 2791 AWHR was performed at our hospital; the overall CMI rate was 2.5%. Of 71 patients, 30 (42.2%) were in BAM group and 41 (57.8%) in SPM group. The median cumulative operative time (252min versus 132min) and length of stay (16.6days versus 6.2days) were significatively longer in SPM group compared with BAM group, due to the need of two surgical procedures. There were a higher number of postoperative complications in SPM group (p = 0.002), some of them grade III. With mean follow-up of 36.5months (range 21-59), there were no significant differences in terms of overall hernia recurrence and mesh reinfection in both groups. The use of a poly-4-hydroxybutyrate resorbable mesh in single-stage management of CMI may be a safe and better option than two-stage approach, although more studies are needed to confirm our results.

Horn-induced traumatic caudoventral abdominal wall hernia management and repair in an adult Highland cow

An adult Highland cow weighing 380 kg presented following a five-day history of inappetence, recumbency and trauma inflicted by herd-mates. Physical exam demonstrated significant swelling of the right ventral abdomen...

Laparoscopic diastasis recti abdominis and midline hernia repair.

Diastasis recti abdominis (DRA) is defined as an abnormally wide distance separates the two rectus muscles. Thinning and widening of the linea alba is an important risk factor for development midline hernia. In patient with DRA there is an increase rate of hernia recurrence. We perform a retrospective study to assess the outcome of laparoscopic intraperitoneal hernia repair and linea alba plication combined with mesh placement to obtain an adequate overlap of midline hernia associated to an abdominal wall support. The inclusion criteria were patients who has a clinical diagnosis of primary midline hernias of any size with associated diastasis recti. The exclusion criteria were incisional hernias, hernias outside of the midline. A total of 12 patients fulfilled the inclusion criteria. No complication was observed over the follow-up period. The rates for recurrence were 0% over the follow-up period. Despite the limited data some assumptions can be drawn from this study. The presence of DRA and coexisting hernia involves a challenging choice of the surgical treatment. Whichever approach is taken, in order to achieve an effective correction, plication of the linea alba is required. The major goal of any abdominal wall repair is not only reduction of hernia sac and prevention of further herniation but also restoration of the integrity and restitution of abdominal wall functionality. A laparoscopic approach to midline hernias associated to DRA is feasible and reproducible. It is necessary future prospective studies on larger numbers to improve knowledge on the management of DRA.

Bioinspired Hydrogel Coating Based on Methacryloyl Gelatin Bioactivates Polypropylene Meshes for Abdominal Wall Repair.

Considering the potential of hydrogels to mimic the cellular microenvironment, methacryloyl gelatin (GelMA) and methacryloyl mucin (MuMA) were selected and compared as bioinspired coatings for commercially available polypropylene (PP) meshes for ventral hernia repair. Thin, elastic hydrated hydrogel layers were obtained through network-forming photo-polymerization, after immobilization of derivatives on the surface of the PP fibers. Fourier transform infrared spectroscopy (FTIR) proved the successful coating while the surface morphology and homogeneity were investigated by scanning electron microscopy (SEM) and micro-computed tomography (micro-CT). The stability of the hydrogel layers was evaluated through biodynamic tests performed on the coated meshes for seven days, followed by inspection of surface morphology through SEM and micro-CT. Taking into account that platelet-rich plasma (PRP) may improve healing due to its high concentration of growth factors, this extract was used as pre-treatment for the hydrogel coating to additionally stimulate cell interactions. The performed advanced characterization proved that GelMA and MuMA coatings can modulate fibroblasts response on PP meshes, either as such or supplemented with PRP extract as a blood-derived bioactivator. GelMA supported the best cellular response. These findings may extend the applicative potential of functionalized gelatin opening a new path on the research and engineering of a new generation of bioactive meshes.

Surgical treatment of massive stoma site tumors after a curative operation for rectal cancer

ObjectiveThis study aimed to evaluate the clinical and oncological outcomes of selected rectal cancer patients with massive stoma site tumors who underwent radical resection and reconstruction. MethodsWe reviewed 8 cases of massive stoma site tumors in patients who had permanent gastrointestinal stoma in the abdominal wall following radical resection of rectal cancer between March 2013 and May 2018 at the Peking University Cancer Hospital and Peking University Shougang Hospital. ResultsThere were seven males and one female patient, with a median age of 50.6 years. The average time between the initial surgery and the development of a malignant tumor at the stoma site was 5 years (range, 0.5–14 years). The average diameter of the stoma site tumors was 8.1 cm, and the diameter of the largest tumor was 12 cm. After tumor resection, the area of the largest abdominal wall defect was about 15 × 14 cm2. Abdominal wall repair included the use of a tensor fasciae latae muscle flap, local fasciocutaneous rotational flap, and pedicled anterolateral thigh flap. No patient died in the 30 days following surgery. The longest follow-up period was 81 months, and 5 patients died. ConclusionsMultidisciplinary clinical management fosters positive outcomes in treating massive stoma site tumors. Local R0 resection and abdominal wall reconstruction are safe and feasible, and function to removes local disease, allowing patients to live a higher quality of life.

The treatment results of patients with postoperative ventral hernias after multi-stage surgery of open abdominal gunshot wounds (improvement of hernioplasty-technique)

Aim: to compare a new technique of the tension-free abdominal wall repair for postoperative ventral hernia after multi-stage surgery of open abdominal gunshot wounds with the open traditional and laparoscopic approaches.Materials and methods. Treatment results of the 86 patients with postoperative ventral hernias after multi-stage surgery of the open abdominal gunshot wounds, which were divided into 2 groups. The main group included 42 patients in whom surgical treatment was carried out according to the developed method of the tension-free abdominal wall repair for postoperative ventral hernia after multi-stage surgical treatment of the open abdominal gunshot wounds. 1st and 2nd comparison group included 44 patients who were undergone an open traditional allohernioplasty and laparoscopic approaches with the composite mesh installation. Treatment results were followed up until 1 year after surgery.Results. In the main group of patients early postoperative complications were observed in 3 (25.0%): postoperative seroma – 2 (16.7%), postoperative wound infiltrate – 1 (8.3). Among patients of 1st and 2nd comparison group cases of postoperative complications were diagnosed in 11 (61.1%): 2 (11.1%) patients – festering wounds, 4 (22.2%) – peri-implant seroma, 3 (16.7%) – infiltration of the surgical wound, 1 (5.6%) – skin edges necrosis, 1 (5.6%) – failure of sutures of the surgical wound. The recurrences of ventral hernias were obtained in 3 (16.7%) patients from comparison group. However, there were no cases of postoperative ventral hernia recurrence in the main group of patients (p = 0.03).Conclusion. А new technique of the tension-free abdominal wall repair for postoperative ventral hernia without disadvantages after multi-stage surgery of the open abdominal gunshot wounds, which allows to reduce the frequency of postoperative complications of surgical treatment and recurrence of the disease.

&lt;p&gt;Electrospun Scaffold with Sustained Antibacterial and Tissue-Matched Mechanical Properties for Potential Application as Functional Mesh&lt;/p&gt;

IntroductionVarious materials and approaches have been used to reduce the mesh-induced inflammatory response and modify the mesh with tissue-matched mechanical properties, aiming to improve the repair of abdominal wall defects.Materials and MethodsIn this study, we fabricated a polycaprolactone (PCL)/silk fibroin (SF) mesh integrated with amoxicillin (AMX)-incorporating multiwalled carbon nanotubes (MWCNTs) via electrospinning, grafting and crosslinking, developing a sustainable antibiotic and flexible mesh. AMX was loaded into the hollow tubular MWCNTs by physical adsorption, and a nanofibrous structure was constructed by electrospinning PCL and SF (40:60 w/w). The AMX@MWCNTs were then chemically grafted onto the surfaces of the PCL/SF nanofibers by treating with 1-ethyl-3-(3-dimethyl aminopropyl) carbodiimide/N-hydroxysuccinimide (EDC/NHS) solution for simultaneous crosslinking and coating. The incorporation of AMX into the MWCNTs (AMX@MWCNTs) and the integration of the AMX@MWCNTs with the PCL/SF nanofibers were characterized. Then, the functional mesh was fabricated and fully evaluated in terms of antibacterial activity, mechanical properties and host response.ResultsOur results demonstrated that the PCL/SF nanofibrous structure was fabricated successfully by electrospinning. After integrating with AMX@MWCNT by grafting and crosslinking, the functional mesh showed undeformed structure, modified surface hydrophilicity and biocompatible interfaces, abdominal wall-matched mechanical properties, and a sustained-release antibiotic profile in E. coli growth inhibition compared to those of PCL/SF mesh in vitro. In a rat model with subcutaneous implantation, the functional mesh incited less mesh-induced inflammatory and foreign body responses than PCL/SF mesh within 14 days. The histological analysis revealed less infiltration of granulocytes and macrophages during this period, resulting in the loosely packed collagen deposition on the functional mesh and prominent collagen incorporation.DiscussionTherefore, this designed PCL/SF–AMX@MWCNT nanofibrous mesh, functionalized with antibacterial and tissue-matched mechanical properties, provides a promising alternative for the repair of abdominal wall defects.

Selection of biological prosthesis for abdominal wall repair on the basis of in vitro biocompatibility determination.

Research on prostheses for repairing abdominal wall defects has progressed through past decades for developing an ideal prosthesis. The study was designed to compare different extracellular matrix (ECM) derived biological prostheses as alternate to conventional synthetic polymeric prostheses for the repair of full thickness abdominal wall defects. Five biological scaffolds derived from bovine diaphragm, bovine aorta, bovine gall bladder, porcine gall bladder, and rabbit skin were prepared and screened for their in vitro biocompatibility. Decellularized ECMs were subjected to various biocompatibility analyses, namely, water absorption potential, matrix degradation analysis, biomechanical testing, and cytocompatibility analysis. Though the rabbit skin displayed maximum biomechanical strength, due to its rapid degradation, it failed to fulfill the criteria of an ideal prosthesis. ECMs derived from bovine diaphragm and aorta were found to be superior than others based upon hydration and matrix degradation analysis, with best scores for bovine diaphragm followed by bovine aorta. The bovine diaphragm and aorta also displayed sufficient biomechanical strength, with diaphragm being the second highest (next to rabbit skin), in biomechanical strength followed by aorta. None of the biological prosthesis revealed any cytotoxicity. Thus, bovine diaphragm and aorta derived ECM fulfill the necessary criteria for their use as biological prosthesis. Because these prostheses are biocompatible, apart from their low cost, ease of availability, and simple preparation, they present a potential alternative to synthetic prosthesis for repair of abdominal wall defects, especially in veterinary patients.

Comparison of Surgical Treatment of Postoperative Abdominal Wall Hernias with and without Fixation of a Synthetic Mesh: Literature Review

Objective. Review articles with postoperative abdominal wall repair without mesh suturing (sutureless hernioplasty). Methods. A systematic search of the literature published from 01/01/2004 to 31/12/2018 was performed using Medline, PubMed and the Cochrane Library databases. The search was performed using the keywords: postoperative hernia, incisional hernia, mesh hernioplasty, sutureless repair, sutureless hernioplasty, sutureless herniotomy. Results. For the present analysis 5 publications were identified. The quality of each study was assessed. The information about operative methods, main results, conclusions and recommendations was collected. Conclusions. According to the results and conclusions of reviewed articles, it can be stated that postoperative abdominal wall hernia repair without mesh suturing is a safe and can improve postoperative results, but there is insufficient evidence to determine if it is associated with better outcomes than hernioplasty with mesh fixation. Further clinical studies are needed to clarify whether this method is clinically important.

Re-do surgery after prosthetic abdominal wall repair: intraoperative findings of mesh-related complications.

Mesh repair is one of the most popular technique for the treatment of abdominal wall hernias, resulting in lower recurrence rates. However, it is associated with a high risk of mesh-related complications. The aim of the present study is to assess the impact of biomaterials on the intra-abdominal organs, in terms of adhesions and visceral complications, in a series of patients undergoing re-do surgery at our abdominal wall unit. We reviewed the clinical records of 301 patients who undergone laparotomy between June 2008 and May 2018, selecting 67 patients with one or more previous prosthetic abdominal wall repair (AWR). The average number of previous repairs was 1.6 with a mean time interval of 66months from the last repair. Clinical presentation included hernia recurrence (69%), mesh infection (26%), infection and recurrence (10%), and fistula (1%). Adhesions were intraoperatively observed in all patients, except for eight cases. Mesh was completely removed in 43 patients, partially in four. Postoperative complications were observed in 39% of cases, including wound dehiscence, hematoma, seroma, and mesh infection. Long-term implant results in abdominal wall repair and are not completely known, and literature is still lacking on this topic. Re-do surgery for subsequent pathological events may represent a way to increase our knowledge.

Poly-4-hydroxybutyrate (Phasix™) mesh onlay in complex abdominal wall repair.

Poly-4-hydroxybutyric acid (P4HB, Phasix™) is a biosynthetic polymer that degrades by hydrolysis that can be woven into a mesh for use in soft tissue reinforcement. Herein, we describe our initial experience performing complex abdominal wall repair (CAWR) utilizing component separation and P4HB mesh as onlay reinforcement. All patients undergoing CAWR between June 2014 and May 2017 were followed prospectively for postoperative outcomes. Only those patients who underwent components separation with primary repair of the fascial edges followed by onlay of P4HB mesh were included in this study. 105 patients (52 male, 53 female; mean age 59.2years, range 22-84) met inclusion criteria. Mean BMI was 29.1 (range 16-48); 52% patients had prior attempted hernia repair, most with multiple medical comorbidities (71% of patients with ASA 3 or greater). 30% of cases were not clean at the time of repair (CDC class 2 or greater). Median follow-up was 36months (range 9-63). Eighteen patients (17%) developed a hernia recurrence ranging from 2 to 36months postoperatively. Five (5%) patients developed a localized superficial infection treated with antibiotics, three (2.8%) required re-operation for non-healing wounds, and six (6%) patients developed seroma. These data demonstrate a relatively low rate of hernia recurrence, seroma, and other common complications of CAWR in a highly morbid patient population. Importantly, the rate of mesh infection was low and no patients required complete mesh removal, even when placed into a contaminated or infected surgical field.

Long-term results of botulinum toxin type A in complex abdominal wall repair and review of the literature.

Administration of botulinum toxin (BTX) is being used in cases of complex ventral hernia for the reconstruction of the linea alba and closure of the abdominal wall. However, there are no published results regarding the long-term effects of BTX and its implication in hernia recurrence. Our purpose is to evaluate the outcomes in hernia recurrence of the administration of BTX in complex ventral hernia repair. 36 patients underwent elective surgery for complex ventral hernia and were evaluated retrospectively. The study included patients with a transverse hernia defect ≥ 100mm and loss of domain hernias, receiving BTX injections 6weeks prior to elective surgery. Global results and long-term recurrence were analysed. There were no complications related to BTX administration. The mean transverse hernia defect was 139.44 ± 50.98mm, the mean abdominal cavity volume (ACV) was 10.19 ± 3.33dm3, the mean hernia sac volume (HSV) was 1.93 ± 1.79dm3, presenting a mean volume ratio (VR) of 20.71 ± 19.76%. Primary closure was achieved in 28 patients (77.8%), 21 of whom (75%) needed an anterior component separation technique. Recurrence rate was 11.4% at 2-years follow-up. BTX administration is a safe and feasible method for abdominal wall expansion prior to complex incisional hernia repair, achieving high rates of primary closure. Long-term follow-up shows good results in terms of recurrence in these patients.

Extended Totally Extraperitoneal (eTEP) Approach for Ventral Hernia Repair: Initial Results

IntroductionSince the first laparoscopic incisional hernia repair, several minimally invasive procedures have been developed in abdominal wall repair. In 2017, the extended totally extraperitoneal (eTEP) approach for abdominal wall repair was published. We present the results from eTEP implementation at two medical centers by one surgeon. MethodsProspective descriptive study of the implementation of the eTEP approach, with transversus abdominis release (TAR) when needed. The surgical technique was initiated by accessing the space between the rectus abdominis muscle and posterior rectus sheath, connecting this space with the fatty preperitoneal space at the midline and the contralateral retrorectal space. Identification and dissection of the hernia sac is performed in the created cavity. Additionally, posterior component release in a TAR fashion could be done. Finally, closure of posterior plane and linea alba is completed and mesh prosthesis is deployed along the whole dissected space. ResultsForty patients underwent an eTEP procedure with 20 supraumbilical defects, 10 infraumbilical and 10 lateral hernias. Sixteen cases required a TAR technique. Mean operative time was 126min. Median pain reported the first postoperative day was 3 on the visual analog scale. Median length of stay was 1 day and mean follow-up was 10 months. Only one patient developed recurrence, and two patients underwent reoperation. ConclusionsImplementation of eTEP in abdominal wall repair is safe. Preliminary outcomes of the eTEP approach in ventral hernia repair show good pain control with less hospital stay.

Abstract QS14: Abdominal Weakness, Bulge Or Hernia After DIEP Flaps: An Algorithm Of Management, Prevention, And Surgical Repair With Classification

Purpose: This study analyzes abdominal weakness, hernia and bulge following DIEP flap breast reconstruction. Abdominal wall morbidities are categorized, and an algorithm for management is provided. Methods: A retrospective review of 718 patients who underwent abdominal based flap breast reconstruction between 2009 and 2018 was performed. Bulge and hernia were evaluated on exam and then by imaging and/or operative exploration. The incidence of abdominal weakness was evaluated by BREASTQ data. Risk factors were analyzed. Results: Of the 644 patients included, 23 (3.6%) had a bulge or hernia on exam postoperatively. Developing an abdominal wound postoperatively and sacrificing nerves both correlated with an increased incidence of bulge or hernia (p < 0.05). The use of lateral row perforators, keeping the umbilicus, higher BMI and the use of mesh in the initial abdominal wall repair trended towards an increased incidence of bulge or hernia; however, this data was not statistically significant. Seven percent of patients who answered the BREAST-Q™ reported abdominal weakness. Patients in the umbilicus sacrificing cohort had an increased incidence of weakness (p < 0.05). Abdominal wounds, nerve sacrificing procedures and obesity correlated with an increased incidence of weakness; this data was not statistically significant. Conclusions: Following analysis, a classification and algorithm for treatment of abdominal wall morbidity is provided. Abdominal wall morbidity is classified as: type 1 - abdominal weakness; type 2 - smaller, unilateral abdominal bulge; and type 3 - true abdominal hernia or large bilateral bulge. An algorithm of treatment is presented which includes physical therapy and surgical repair recommendations.

Vía totalmente extraperitoneal extendida (eTEP) para la corrección de hernias ventrales: resultados preliminares

IntroductionSince the first laparoscopic incisional hernia repair, several minimally invasive procedures have been developed in abdominal wall repair. In 2017, the extended totally extraperitoneal (eTEP) approach for abdominal wall repair was published. We present the results from eTEP implementation at two medical centers by one surgeon. MethodsProspective descriptive study of the implementation of the eTEP approach, with transversus abdominis release (TAR) when needed. The surgical technique was initiated by accessing the space between the rectus abdominis muscle and posterior rectus sheath, connecting this space with the fatty preperitoneal space at the midline and the contralateral retrorectal space. Identification and dissection of the hernia sac is performed in the created cavity. Additionally, posterior component release in a TAR fashion could be done. Finally, closure of posterior plane and linea alba is completed and mesh prosthesis is deployed along the whole dissected space. ResultsForty patients underwent an eTEP procedure with 20 supraumbilical defects, 10 infraumbilical and 10 lateral hernias. Sixteen cases required a TAR technique. Mean operative time was 126minutes. Median pain reported the first postoperative day was 3 on the visual analogue scale. Median length of stay was 1 day and mean follow-up was 10 months. Only one patient developed recurrence, and two patients underwent reoperation. ConclusionsImplementation of eTEP in abdominal wall repair is safe. Preliminary outcomes of the eTEP approach in ventral hernia repair show good pain control with less hospital stay.