In this video, we will discuss that The landscape of hernia surgery is rapidly evolving, and one technique that has captured the spotlight at the WALS 2025 Conference is the Enhanced View Totally Extraperitoneal (eTEP) approach for groin hernia repair. Touted as a revolutionary advancement in minimally invasive hernioplasty, eTEP offers numerous advantages over traditional TEP and TAPP techniques. This video, titled "eTEP for Groin Hernia Repair: A Minimally Invasive Revolution – Insights from WALS 2025 Conference," explores expert perspectives, technical pearls, and surgical outcomes associated with this game-changing approach.

Understanding the eTEP Approach

Developed to optimize the working space in the preperitoneal plane, the eTEP technique allows surgeons to access bilateral inguinal regions through a more ergonomic and anatomically favorable dissection route. Unlike standard TEP, eTEP starts with a higher port placement in the anterior abdominal wall, typically near the linea semilunaris, and utilizes balloon or blunt dissection to create a large preperitoneal working space.

This expanded view improves visibility and dissection control, reduces the risk of peritoneal breach, and facilitates tension-free mesh placement with better prosthetic overlap.

Key Highlights from the WALS 2025 Discussion

Broader Surgical Field and Enhanced Ergonomics

Surgeons at WALS 2025 emphasized how the eTEP technique provides a wider operative field, allowing easier management of large, bilateral, or recurrent hernias with improved instrument handling and surgeon comfort.

Reduced Peritoneal Violation and Complication Risk

By avoiding entry into the peritoneal cavity, the eTEP approach reduces complications such as visceral injury, bowel adhesions, and port-site hernias—factors often seen in TAPP repairs.

Precision Mesh Placement

With better visualization of the myopectineal orifice, surgeons can ensure complete dissection and placement of a large, flat mesh with optimal overlap, reducing the risk of recurrence.

Learning Curve and Training

While eTEP offers significant advantages, WALS faculty noted that surgeon training is critical, as the approach demands familiarity with preperitoneal anatomy, port planning, and dissection technique.

Postoperative Outcomes

Clinical data shared at the conference showed promising results, including minimal postoperative pain, early return to work, and low complication rates—making eTEP a strong contender for the new standard in inguinal hernia repair.

Applications and Indications

Unilateral and bilateral inguinal hernias
Recurrent hernias post-open repair
Athletic pubalgia (sports hernia)
Complex or large hernia defects

Conclusion

The eTEP approach for groin hernia repair represents a paradigm shift in minimally invasive surgery, combining the advantages of laparoscopy with enhanced anatomical exposure and reduced patient trauma. As demonstrated at the WALS 2025 Conference, this technique is not just an alternative but a forward-thinking solution for modern hernia surgeons seeking to elevate outcomes while preserving safety and surgical finesse.

Watch the full video for expert commentary, intraoperative visuals, and practical tips on implementing eTEP in your surgical practice. Don’t forget to like, comment, and subscribe for more updates from WALS and World Laparoscopy Hospital.