Purpose: The extended totally extraperitoneal technique (eTEP) is a relatively new laparoscopic approach to address ventral hernias. Since this technique is not widely used yet, the literature regarding its efficacy and safety is limited, especially when compared to more established surgical techniques like intraperitoneal onlay mesh (IPOM). This study aimed at contributing to the expanding body of evidence for eTEP, by comparing the early outcomes of eTEP and IPOM surgeries for ventral hernias. Methods: This monocentric, retrospective cohort study compared patients with ventral hernias that were treated with eTEP or IPOM from 2019 to 2023. Results: A total of 123 patients were analysed. 92 underwent eTEP and 31 IPOM respectively. Both groups were overall comparable. The IPOM group had a higher proportion of incisional hernias (61,29% vs. 21,74%, p < 0,001). This was taken into account for in a subgroup analysis of only primary hernias. The IPOM group had a significantly longer admission time (eTEP: 3 days, IPOM: 4 days, p < 0,001). The subgroup analysis revealed a statistically significant shorter surgery time in IPOM (median of 66,5 min vs. 106,5 min; p = 0,043) and a lower rate of postoperative complications in eTEP (eTEP: 4,17%, IPOM: 25%. p = 0,009). The eTEP group reported lower postoperative pain, yet without statistical significance. Conclusion: eTEP for ventral hernia repair appears to be non-inferior to IPOM. Compared to IPOM it leads to shorter postoperative hospital stay and a potentially lower complication rate, despite a longer operation time.

Aim: Surgical resection remains the treatment of choice for curable esophageal cancer patients. Anastomotic leakage after esophagectomy with an intrathoracic anastomosis is the most feared complication, and is the main cause of postoperative morbidity and mortality. The aim of this study was to identify risk factors associated with anastomotic leakage and its effect on the postoperative outcome. Methods: Between 2012 and 2022, all patients who underwent Ivor Lewis esophagectomy for underlying malignancy were included in this study. We performed a retrospective analysis of 174 patients. The dataset was analyzed to identify risk factors for the occurrence of anastomotic leakage. Results: A total of 174 patients were evaluated. The overall anastomotic leakage rate was 18.96%. The 30-day mortality rate was 8.62%. Multivariate logistic regression analysis identified diabetes (p = 0.0020) and obesity (p = 0.027) as independent risk factors associated with anastomotic leakage. AL had a drastic effect on the combined ICU/IMC and overall hospital stay (p < 0.001. Conclusion: Anastomotic leakage after esophagectomy with intrathoracic anastomosis is the most feared complication and major cause of morbidity and mortality. Identifying risk factors preoperatively can contribute to better patient management.

Background: The extended totally extraperitoneal technique (eTEP) is a novel approach for ventral hernia repair. This technique has been recently advanced using robotics (r-eTEP). The aim of this study is to perform a comprehensive analysis of the initial results of r-eTEP and to evaluate the safety and efficacy of this technique compared to the eTEP technique. Methods: This is a monocentric retrospective study of patients with ventral hernias who underwent surgery via eTEP or r-eTEP in our department between 2019 and 2023. Propensity score matching was applied to compare the groups. Preoperative patient and hernia characteristics, intraoperative findings, and postoperative outcomes were subsequently analysed. Results: Patient demographics were comparable between the groups. The r-eTEP group had a significantly greater proportion of M3 hernias ( p = 0.006), M4 hernias ( p = 0.020), incisional hernias ( p = 0.002), and hernias with rectus diastasis ( p < 0.001). The r-eTEP group had a significantly larger hernia defect ( p = 0.003) and larger mesh size ( p = 0.015). The r-eTEP group had a shorter hospital stay ( p < 0.001) and shorter operative time, though not statistically significant ( p = 0.211). Intraoperative and postoperative complications, as well as postoperative pain, were comparable between the groups. Conclusion: The findings of the present study show that the r-eTEP technique may offer potential benefits as the overall hospital stay was shorter while intraoperative and postoperative complications were comparable for both techniques.

Robotic ventral hernia repair (rVHR) is an advanced form of minimally invasive surgery that offers enhanced precision, reduced complications, and faster recovery time. However, direct comparisons between enhanced-view totally extraperitoneal (eTEP) and transabdominal preperitoneal (TAPP) approaches remain limited. This study aimed to compare the safety and clinical outcomes of eTEP and TAPP in rVHR. In this retrospective cohort study, 117 patients underwent rVHR (82 eTEP, 35 TAPP) between 2023 and 2024. Propensity score matching (PSM) (1:1) balanced baseline characteristics, resulting in 33 patients per group. Patient demographics, operative data, and postoperative outcomes were collected from electronic medical records. Statistical analyses were conducted using SPSS, with statistical significance defined as p < 0.05. Following matching, eTEP demonstrated significantly longer operative times (median 115 vs. 83 min, p = 0.004) and larger mesh sizes (420 cm ² vs. 195 cm ² , p = 0.001). Surgical drains were more frequently used in eTEP (48.4% vs. 3%, p = 0.001). Postoperative outcomes, length of hospital stay, and pain scores did not differ significantly between the groups. Surgical site occurrences (SSOs) showed no significant difference between groups (18.1% eTEP vs. 9% TAPP, p = 0.475). Both eTEP and TAPP are safe and effective robotic approaches for ventral hernia repair with comparable clinical outcomes. The longer operative time and larger mesh size in eTEP suggests its preferential use in more complex hernia cases requiring detailed anatomical reconstruction.

Background: Ventral hernias are common abdominal wall defects requiring surgical repair to prevent complications. This study compared two techniques: minimally invasive enhanced-view totally extraperitoneal (eTEP) approach and the open sublay (OS) method, historically regarded as the gold standard. Methods: A retrospective single-center study was conducted between July 2019 and March 2023 at the Department for General and Visceral Surgery, Klinikum Oldenburg. All patients who underwent either eTEP or OS for ventral hernia repair were included. Patient demographics and perioperative data were collected and compared. Results: A total of 139 patients were analyzed, with 92 undergoing eTEP repair and 47 undergoing OS. Both groups were comparable in demographic and clinical characteristics. Significant differences were found in defect size (median 6 cm² for eTEP vs. 16 cm² for OS, p < 0.028) and mesh size (median 450 cm² for eTEP vs. 150 cm² for OS p < 0.001). Operative time (p = 0.119) and postoperative pain levels over 3 days showed no significant differences (VAS Day1 p = 0.884; VAS Day3 p = 0.636). Intraoperative complications were 2.17% for eTEP and 6.38% for OS (p = 0.207). Postoperative complications (6.52% vs. 21.28%, p = 0.009) and hospital stay (median 3 days vs. 5 days, p < 0.001) were significantly lower in the eTEP group. Conclusions: eTEP is a safe, effective procedure and appears to offer more advantages than OS for ventral hernia repair. It is associated with a significantly lower complication rate, as well as shorter hospital stay.

Background and Objectives: Though widely used, only limited data is available that shows the superiority of hybrid minimally-invasive esophagectomy (HMIE) compared to open esophagectomy (OE). The present study aimed to analyze postoperative morbidity, mortality, and compare lengths of hospital stay. Materials and Methods: A total of 174 patients underwent Ivor Lewis esophagectomy in our surgical department, of which we retrospectively created a matched population of one hundred (HMIE n = 50, OE n = 50). Morbidity and mortality data was categorized, analyzed, and risk factor analyzed for complications. Results: The oncological results were found to be comparable in both groups. A median of 23.5 lymphnodes were harvested during OE, and 21.0 during HMIE. Negative tumor margins were achieved in 98% of OE and 100% of HMIE. In-hospital mortality rate showed no significant difference between techniques (OE 14.0%, HMIE 4.0%, p = 0.160). Hospital (OE Median 23.00 days, HMIE 16.50 days, p = 0.004) and ICU stay (OE 5.50 days, HMIE 3.00 days, p = 0.003) was significantly shorter after HMIE. The overall complication rate was 50%, but complications in general (OE 70.00%, HMIE 30%, p < 0.001) as well as severe complications (Clavien Dindo ≥ III: HMIE 16.0%, OE 48.0%, p < 0.001) were significantly more common after OE. In multivariate stepwise regressions the influence of OE proved to be independent for said outcomes. We observed more pulmonary complications in the OE group (46%) compared to HMIE patients (26%). This difference was statistically significant after adjustment for sex, age, BMI, ASA classification, histology, neoadjuvant treatment or not, smoking status, cardiac comorbidities, diabetes mellitus, and alcohol abuse (p = 0.019). Conclusions: HMIE is a feasible technique that significantly decreases morbidity, while ensuring equivalently good oncological resection compared to OE. HMIE should be performed whenever applicable for patients and surgeons.