eTEP TAR for Ventral Hernias
摘要
Component separation techniques have been developed to decrease tension at the linea alba during the closure of large ventral hernias. Posterior component separation, or transversus abdominis release (TAR), is used for treating large ventral hernias at various locations in the abdominal wall (Novitsky YW et al, Am J Surg 204(5):709–716, 2012). The potential benefits of the TAR technique include reducing the risk of skin devascularization, preventing skin necrosis, and minimizing seroma formation. Additionally, it allows for mesh placement in the retromuscular position (Novitsky YW et al, Ann Surg 264(2): 226-232, 2016; Blatnik JA et al, JAMA Surg 151(4):383–384]. This technique can be performed entirely through minimally invasive surgery, either laparoscopically or robotically (Martin-Del-Campo LA et al, Surg Endosc 32(2): 840–845, 2018; Grossi JVM et al, Hernia 25(6):1715–1725, 2021]. The eTEP technique was originally developed by Dr. Jorge Daes for treating inguinal hernias (Daes J, Surg Endosc 26(4):1187–1189, 2012). Building on this foundational work, Dr. Igor Belyansky and colleagues developed the eTEP Rives-Stoppa and eTEP-TAR techniques, which have been successfully replicated by many surgeons worldwide, showing excellent results in terms of hernia recurrence and morbidity (Daes J, Surg Endosc 26(4):1187–1189, 2012; Daes J, Belyansky I, J Am Coll Surg 233(2):e1–e11, 2021; Quezada N et al, Surg Endosc 36(1):632–639, 2022; Belyansky I, et al, Hernia 22(5):837–847, 2018). In this chapter, we will review the surgical steps, tips, and pitfalls of the laparoscopic eTEP-TAR technique. While this procedure is fundamentally the same as the open and robotic approaches, the use of straight surgical instruments makes it more complex. Therefore, we will discuss specific tips and potential pitfalls to aid in its successful execution.