To investigate a novel minimally invasive approach (enhanced-view totally extraperitoneal technique, eTEP) for the repair of midline ventral hernias. The procedure was described in details, and the safety and efficacy was evaluated.

Retrospective review of consecutive endoscopic retromuscular hernia repair cases utilizing the eTEP technique from the sixth people's hospital of Huizhou between January 2019 and January 2020 was conducted. The hernias of middle and upper abdomen were treated by a bottom-up (cephalad) eTEP repair, while the middle and lower abdomen hernias were treated by top-down eTEP repair. The perioperative data and postoperative complications will be collected and evaluated.

Eighteen patients were included in our cohort, with 7 cases of umbilical hernia, 6 epigastric primary hernia, 3 epigastric incisional hernia and 2 hypogastric incisional hernia. All operations were successfully performed without conversion. Thirteen cases were conducted by bottom-up eTEP approach and the rest were treated by top-down approach. The mean operative time, postoperative pain and length of hospital stay were 130 min, 2.6 (VAS) and 4.6 days, respectively. The mean width of hernia defect was 3.3 cm. The length of mesh was ranged from 15-25 cm, and the width was 13-17 cm. During a mean follow-up of 13 months, no recurrence was observed.

The eTEP technique is safe and feasible for midline defect repair. It combines the advantages of MIS surgery, requires neither expensive anti-adhesive barrier mesh nor traumatic fixation, making it a cost-effective alternative for midline ventral hernia repair.