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eTEP for Groin Hernia Repair: A Minimally Invasive Revolution - Insights from WALS 2025 Conference

The evolution of hernia surgery has consistently aimed at reducing morbidity, improving outcomes, and enhancing patient recovery. At WALS 2025, Dr. Deepak Subramanian delivered a compelling presentation on Extended Totally Extraperitoneal (eTEP) repair for groin hernias, emphasizing its advantages over conventional laparoscopic and robotic approaches. What is eTEP? eTEP (Extended Totally Extraperitoneal) is an advanced variation of the traditional Totally Extraperitoneal (TEP) technique, designed to provide a larger working space and better anatomical exposure, particularly in complex or recurrent groin hernia cases. Advantages of eTEP Over Conventional Techniques • Wider Preperitoneal Space: Allows better visualization and dissection • Minimized Risk of Peritoneal Breach: Reduces the likelihood of complications • Ideal for Bilateral and Recurrent Hernias: Facilitates easy contralateral access • Less Postoperative Pain and Faster Recovery: Due to reduced intra-abdominal pressure and trauma • Feasible in Patients with Previous Lower Abdominal Surgery: Avoids intra-abdominal adhesions Technical Steps of eTEP for Groin Hernia Repair 1. Port Placement • Optical Entry: Typically initiated at a high supraumbilical or lateral site • Creation of Preperitoneal Space: Blunt dissection using CO₂ insufflation • Working Ports: Strategically placed for optimal triangulation 2. Dissection of the Myopectineal Orifice • Identification of Key Structures: Inferior epigastric vessels, pubic tubercle, and iliopubic tract • Hernia Sac Reduction: Careful separation from cord structures 3. Mesh Placement and Fixation • Wide Prosthetic Coverage: Extends beyond the hernia defect to minimize recurrence • Non-Fixation or Limited Fixation: Reduces postoperative pain while ensuring stability 4. Closure of the Preperitoneal Space • Deflation of CO₂ and Skin Closure Clinical Outcomes and Future Prospects • Studies indicate that eTEP provides superior outcomes, particularly for bilateral and recurrent hernias, compared to traditional TEP and TAPP techniques. • Lower conversion rates to open surgery and fewer complications have been observed. • With growing expertise and advancements in minimal access techniques, eTEP is emerging as the preferred approach for complex groin hernias. Conclusion Dr. Deepak Subramanian’s presentation at WALS 2025 highlighted the efficacy, safety, and technical superiority of eTEP in modern hernia repair. As minimal access surgery continues to evolve, eTEP is set to become a cornerstone in the management of groin hernias, offering patients a faster recovery and better long-term outcomes.