Investigating a novel approach to treat primary midline ventral hernia—Subxiphoid top-down endoscopic totally extraperitoneal approach (TEA). The procedure will be described in details and the safety and efficacy evaluated.

During November 2019 and January 2020, six consecutive cases of primary umbilical ventral hernias were repaired using the subxiphoid top-down TEA procedure. A large mesh could be placed in the preperitoneal position using this minimally invasive surgery.

All operations were successful without open conversion. The mean operation time was 164 minutes (120 to 240 minutes). Postoperative pain was mild and the mean visual analogue pain scale (VAS) was 2.2 on first postoperative day. The average postoperative stay in hospital was 2.2 days (2 to 3 days). One case experienced postoperative mild seroma but without adverse impact on the final outcome and no recurrences during the follow-up period of 6 to 15 weeks.

Subxiphoid top-down TEA procedure is a safe, feasible and minimally invasive alternative for the surgical treatment of primary ventral hernia. It is an effective supplement of the TEA technique which could expand its indications. This technique is worthy recommended to experienced hernia surgeon.