The carolinas crossover, a preperitoneal crossover for enhanced-view totally extraperitoneal (eTEP) ventral hernia repair (VHR): a novel technique.

Purpose: To present a novel technique of preperitoneal cross-over for eTEP VHR.

Methods: Patients who underwent robotic eTEP with mesh utilizing a preperitoneal cross over technique were identified using a single-institution hernia database. This novel technique involves minimally invasive access to the retro-rectus space on one side with midline cross over into the preperitoneal space on the contralateral side. Baseline demographics of the patients were obtained, and intra-operative and post-operative outcomes were reported.

Results: Nine VHR patients underwent robotic eTEP with mesh using a preperitoneal crossover technique. Five patients were male, mean age was 53 ± 18.4 years, and mean BMI was 32.5 ± 4.2 kg/m. Two patients were diabetic and 2 were previous smokers. Two of the hernias were recurrent. The average hernia defect was 96.9 ± 45.5 cm and the average mesh size was 593.3 ± 168.2 cm. Four patients underwent a unilateral TAR, while five patients did not require any component separation. All cases were CDC Class 1 wounds. All patients met discharge criteria on post-operative day 1. There was one post-operative wound occurrence which was a seroma. There were no infectious complications and no hernia recurrences. The average follow up was 1.4 ± 1.2 months.

Conclusions: Preperitoneal cross-over during eTEP ventral hernia technique is a safe technique that allows placement of a large extra-peritoneal mesh. Early patient outcomes are favorable. Larger sample size and follow-up are needed to truly assess postoperative outcomes.