Munoz-Rodriguez Joaquín M, Román García de León Laura, Polaino Moreno Verónica, Fernández Rodríguez Manuel, Grillo Marín Cristián, Blazquez-Hernando Luis A, Robin Valle De Lersundi Álvaro, Medina Pedrique Manuel, Lucena de la Poza José Luis, Garcia-Urena Miguel A, Lopez-Monclus Javier
Puerta de Hierro University Hospital. C. Joaquín Rodrigo, Autónoma de Madrid University, 1, 28222 Majadahonda, Madrid, Spain.
Ramón y Cajal University Hospital, Alcala de Henares University, M-607, 9, 100, 28034, Madrid, Spain.
Surg Endosc. 2025 Apr;39(4):2729-2742. doi: 10.1007/s00464-025-11643-2. Epub 2025 Mar 13.
Minimally invasive techniques are widely used to treat abdominal wall defects. This study describes a cranial approach for performing the total preperitoneal/pretransversalis enhanced-view totally extraperitoneal (PeTEP) technique and presents early outcomes for treating primary ventral hernias (PVH), midline trocar site incisional hernias (IHs), both associated with rectus diastasis, as well as lateral IHs.
An observational study was conducted from October 2023 to September 2024, identifying cases where the cranial PeTEP technique was employed, using data from a multicentric prospectively maintained database. The cranial approach involved dissection of the preperitoneal fatty rhomboid, extending the dissection across the preperitoneal and transversalis fascial plane to the semilunar lines laterally and the pubis caudally. For lateral defects, the dissection extended beyond the ipsilateral semilunar line, surpassing the lateral edge of the defect.
Twenty-four patients underwent elective endoscopic hernia repair: 62.5% PVH, 29.2% midline IH, and 8.3% lateral IH. The mean defect area was 6.32 ± 6.13 cm, and the average mesh size was 497.21.41 ± 202.71 cm. The surgical site occurrences rate was 8.3%, with no surgical site infections or recurrences at a mean follow-up of 5.3 months.
The cranial PeTEP technique was a safe, effective, and reproducible method for repairing PVH and small-medium IHs associated with rectus diastasis in a selected cohort of patients. It facilitated large preperitoneal mesh placement without entering the retromuscular plane and avoided posterior component separation in lateral defects. Larger studies with extended follow-up are needed to confirm these promising results.
微创技术广泛应用于腹壁缺损的治疗。本研究描述了一种用于实施全腹膜前/腹横筋膜增强视野完全腹膜外（PeTEP）技术的经颅入路，并展示了治疗原发性腹直肌分离相关的腹正中疝（PVH）、中线套管针部位切口疝（IHs）以及外侧IHs的早期疗效。
2023年10月至2024年9月进行了一项观察性研究，利用一个多中心前瞻性维护数据库的数据，确定采用经颅PeTEP技术的病例。经颅入路包括解剖腹膜前脂肪菱形区，将解剖范围扩展至腹膜前和腹横筋膜平面，外侧至半月线，尾侧至耻骨。对于外侧缺损，解剖范围超出同侧半月线，超过缺损的外侧边缘。
24例患者接受了择期内镜疝修补术：62.5%为PVH，29.2%为中线IH，8.3%为外侧IH。平均缺损面积为6.32±6.13平方厘米，平均补片大小为497.21.41±202.71平方厘米。手术部位发生率为8.3%，平均随访5.3个月时无手术部位感染或复发。
经颅PeTEP技术是一种安全、有效且可重复的方法，用于修复特定患者群体中与腹直肌分离相关的PVH和中小型IHs。它便于放置大的腹膜前补片而不进入肌后平面，并避免外侧缺损的后入路成分分离。需要进行更大规模、更长随访期的研究来证实这些有前景的结果。
