Preperitoneal enhanced-view totally extraperitoneal (PeTEP) technique in midline and lateral incisional hernia repair: Early multicenter outcomes.

Abstract

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. 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. 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. 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.