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eTEP — Extended Totally Extraperitoneal Hernia Repair

Advanced minimally invasive technique extending the extraperitoneal preperitoneal plane laparoscopically or robotically to perform inguinal, ventral, and incisional hernia repair without entering peritoneum and with mesh placement in retromuscular space.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is eTEP — Extended Totally Extraperitoneal Hernia Repair?

Extended totally extraperitoneal (eTEP) approach was developed by Daes for inguinal hernia and adapted by Belyansky for ventral hernia (eTEP-RS, eTEP-TAR); the technique establishes a working space between transversus abdominis and posterior rectus sheath without entering peritoneal cavity.

Compared with traditional TEP for inguinal hernia, eTEP allows port placement away from the lower abdomen with greater spatial flexibility for bilateral, large, or scrotal hernias; for ventral hernia, it provides retromuscular mesh placement avoiding intraperitoneal contact.

eTEP for ventral hernia replicates Rives-Stoppa or transversus abdominis release (TAR) principles via a minimally invasive approach, with mesh placed in retro-rectus or pre-peritoneal space, defect closure, and overlap of 5 cm or more.

Symptoms

Bilateral inguinal hernia, recurrent inguinal hernia, large or scrotal inguinal hernia ideal for eTEP-Inguinal
Ventral or incisional hernia with defect 4–10 cm width amenable to retromuscular mesh placement (eTEP-RS) or up to 12 cm with TAR component
Patients seeking minimally invasive option but with hernia size beyond classic IPOM range
Avoidance of intraperitoneal mesh in young patients, patients with planned future abdominal surgery, or after peritoneal contamination concerns
Symptoms: bulge, pain, dragging sensation, dyspareunia in groin hernia, cosmetic concern in midline hernia
Patients suitable for general anesthesia and pneumopreperitoneum without severe cardiopulmonary risk

Risk Factors

Prior abdominal surgery with severe adhesions to anterior abdominal wall — relative contraindication or technical challenge
Body mass index over 35 — higher complication rates, longer operating time
Coagulation disorders, active anticoagulation needing bridging therapy
Severe COPD, NYHA class III–IV heart failure unsuitable for prolonged Trendelenburg position
Steep learning curve — requires advanced laparoscopic suturing and intracorporeal knot tying skills
Lack of robotic platform availability for robotic-assisted eTEP in centers preferring that approach

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Bilateral or recurrent inguinal hernia — surgical evaluation for eTEP-Inguinal versus alternative
  • Ventral or incisional hernia with defect 4–10 cm — discussion of eTEP-RS, eTEP-TAR, IPOM-Plus, or open Rives-Stoppa
  • Failed prior hernia repair — referral to abdominal wall reconstruction specialist
  • Acute inguinal or ventral hernia incarceration — emergency surgery, eTEP rarely feasible in emergent setting
  • Persistent groin pain after prior repair — diagnostic workup and tailored repair selection

Treatment Methods

01
Preoperative optimization including weight reduction, glycemic control, smoking cessation, and CT abdominal wall planning for ventral hernia
02
eTEP-Inguinal: laparoscopic ports above and lateral to umbilicus, balloon dissection, large mesh placement (15×10 cm bilateral) without fixation in many cases
03
eTEP-RS for ventral hernia: ports lateral to rectus, retro-rectus dissection, defect closure with continuous suture, retromuscular mesh placement with sublay technique, overlap ≥5 cm
04
eTEP-TAR adds posterior component separation by transversus abdominis release for defects beyond 8 cm or for medial dissection extension; mesh up to 30×30 cm
05
Postoperative: abdominal binder, early ambulation, multimodal analgesia, DVT prophylaxis, and follow-up at 4 weeks, 3 months, 6 months, then annually with clinical or imaging assessment

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.