BACKGROUND The Rives-Stoppa procedure is used for ventral hernia repair but requires a large midline incision. This report describes a new, totally endoscopic approach to the retromuscular plane, corresponding to a reversed totally extraperitoneal procedure, to perform sublay repair of primary and secondary ventral hernias. This totally endoscopic sublay (TES) repair is described in detail, and its safety and efficacy were evaluated. METHODS In this prospective study, we assessed 26 consecutive primary and secondary epigastric midline ventral hernias that were repaired between July 2017 and July 2018 using the TES procedure. A large mesh was placed in the retrorectus position using this minimally invasive approach. Indications for this procedure include umbilical, epigastric, incisional hernias, and rectus diastasis. RESULTS All TES procedures were successfully performed without conversion to an open operation. The mean operative time was 106.6 ± 29.1 min (range 75-205), with average mesh area of 318.8 cm2 for an average defect area of 26.5 cm2. Postoperative pain was mild, and the mean visual analog scale (VAS) under physical stress (e.g., climbing stairs) was 2.4 at the third postoperative day. The average postoperative hospital stay was 2.8 ± 0.8 days (range 2-5). Two patients developed postoperative seroma, with no final adverse effect. No recurrence nor readmissions within 30 days was observed during a mean follow-up of 9.2 ± 4.4 months. CONCLUSIONS Initial experiences with this technique show that the TES procedure is safe and reliable, requires no specific instruments, and is highly reproducible. There is no need for an expensive anti-adhesion mesh or fixation device, making it cost-effective.

中文翻译：

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中线腹疝的全内窥镜下层 (TES) 修复：手术技术和初步结果。

背景 Rives-Stoppa 手术用于腹疝修复，但需要大的中线切口。本报告描述了一种新的、完全内窥镜的肌肉后平面方法，对应于反向完全腹膜外手术，用于对原发性和继发性腹疝进行亚层修复。详细描述了这种完全内窥镜下层 (TES) 修复，并评估了其安全性和有效性。方法 在这项前瞻性研究中，我们评估了 26 例在 2017 年 7 月至 2018 年 7 月期间使用 TES 程序修复的连续原发性和继发性上腹中线腹疝。使用这种微创方法将大网状物放置在直肌后位置。该手术的适应症包括脐、上腹、切口疝和直肌分离。结果 所有 TES 程序均成功执行，无需转换为开放式操作。平均手术时间为 106.6 ± 29.1 分钟（范围 75-205），平均网孔面积为 318.8 平方厘米，平均缺损面积为 26.5 平方厘米。术后疼痛轻微，术后第三天在身体压力（如爬楼梯）下的平均视觉模拟评分（VAS）为 2.4。术后平均住院时间为 2.8 ± 0.8 天（范围 2-5）。两名患者出现术后血清肿，无最终不良反应。在 9.2 ± 4.4 个月的平均随访期间，未观察到 30 天内复发或再入院。结论 使用该技术的初步经验表明，TES 程序安全可靠，不需要特定仪器，并且具有高度可重复性。