Minimally invasive techniques · Retromuscular plane

eTEP and r-eTEP: working within the wall, without entering the abdominal cavity

The eTEP — Enhanced-view Totally Extraperitoneal repair is a minimally invasive technique for treating abdominal wall defects by working within the thickness of the wall itself, in the retromuscular space (between the muscle and the posterior fascia), without placing the mesh in contact with the bowel.

01

Indications

It may be indicated for

3
Incisions

small access sites at the side or below the underwear line

02

How the procedure is performed

  1. I
    Creating the retromuscular space

    The surgeon develops a pocket behind the rectus muscles, avoiding entry into the peritoneal cavity.

    Creation of the retromuscular pocket.
  2. II
    Reconstructing the midline

    The wall defects are closed and the midline is reconstructed with sutures. When an associated diastasis is present, the reconstruction includes bringing the rectus muscles back together.

    Midline reconstruction using sutures.
  3. III
    Placing the mesh

    The mesh is placed behind the muscles, in the retromuscular position, separated from the peritoneum and therefore from the bowel. This is one of the main anatomical advantages of the technique.

    Mesh placement.
    Retromuscular plane for the mesh.

Why the retromuscular plane matters

The retromuscular plane allows the mesh to act as reinforcement of the reconstruction, keeping it in a deep, protected position.
The mesh is therefore not simply laid over the defect, but placed within an anatomical plane that spreads tension over a wider surface.
It also avoids direct contact between the mesh and the bowel loops, which is particularly important in abdominal wall reconstruction.
Learn moreMesh in diastasis repair
03

Laparoscopy or robotics

The same reconstruction can be performed using:

Laparoscopic
eTEP
Robotic
r-eTEP

Robotics is particularly helpful for deep dissections and complex suturing.

Learn moreRobotic abdominal wall surgery

Plastic surgery

Possible combination with plastic surgery

Where indicated, functional reconstruction can be combined with aesthetic remodelling of the abdominal wall performed by the plastic surgery team.

Learn moreAesthetic remodelling of the abdominal wall

Timing and hospital stay

  1. About 2h

    Duration of surgery

  2. After 2h

    Up and about, and eating again

  3. Discharge

    After 1 night in hospital

Approximate duration of about 2 hours and usually one night in hospital: timings may vary with the complexity of the reconstruction.

Post-operative recovery

immediate

  • Straight awayImmediate return to daily activities
  • End of rehabilitationGradual return to physical activity, at the end of the rehabilitation programme
Rehabilitation after surgery
All minimally invasive techniques

Frequently asked questions

Is the mesh placed inside the abdomen?

No. In eTEP the mesh is placed in the retromuscular space, separated from the peritoneal cavity and the bowel.

Can eTEP also correct diastasis?

Yes, in selected patients it allows the midline to be reconstructed together with treatment of associated hernias.

Can eTEP be performed robotically?

Yes. The technique can be performed either laparoscopically or robotically.

How long is the hospital stay?

Usually one night in hospital, although recovery depends on the extent and complexity of the procedure.

Not every hernia needs the same reconstruction

eTEP is one of the possible strategies for working outside the abdominal cavity, reconstructing the midline and placing the mesh in the retromuscular position. The technique is chosen after assessing the type of defect, any associated diastasis, previous surgery and the quality of the abdominal wall.

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