Laparoscopic Extraperitoneal Repair with Upfront Coring out of Hernia Defect for Ventral Hernia.

Backgrounds and Objectives: The enhanced-view totally extraperitoneal technique (eTEP) has gained popularity as a novel minimally invasive ventral hernia repair approach. However, this procedure becomes technically demanding once the view is no longer maintained, due to incidental pneumoperitoneum caused by peritoneal injury during the surgery. In an attempt to overcome this technical issue, we report laparoscopic extraperitoneal repair with upfront coring out of hernia defect (LERCO) where the intraperitoneal coring out of the hernia defect precedes the regular eTEP for the treatment of midline incisional ventral hernia. Methods: A total of nine patients with midline incisional ventral hernia were treated by LERCO. In the first step, 3 ports are inserted into the peritoneal cavity. The half circumference of the hernia defect is cored out and the extraperitoneal space is further dissected. Then, an additional 3 ports are inserted in the dissected extraperitoneal space. The remaining half circumference of the hernia defect is cored out and the dissection of the extraperitoneal space around the hernia defect is completed. Subsequently, the hernia defect as well as posterior sheath and peritoneum are reapproximated and the mesh is deployed in the extraperitoneal space. Results: In this series of patients, there was no open conversion during the surgery nor severe postoperative complications including hernia recurrence. Conclusion: LERCO secures the procedure under the optimal field of view during midline incisional ventral hernia repair. Although our results are promising, further accumulation of clinical experiences is warranted.