eTEP Suprapubic Approach (eTEP-SA): Expanding the Horizons of the eTEP Rives-Stoppa for Ventral Hernia and Rectus Diastasis Repair

The enhanced-view totally extraperitoneal suprapubic approach (eTEP-SA) has emerged as an innovative evolution of the classical eTEP Rives-Stoppa technique for ventral hernia and rectus diastasis repair. Conceived to address the ergonomic limitations of the standard eTEP, eTEP-SA was designed to optimize surgeon comfort, shorten operative time, and enhance cosmetic outcomes, all while preserving the core principles of durable repair and the well-established benefits of retromuscular mesh placement. Early reports have consistently confirmed its safety, reproducibility, and low morbidity in appropriately selected patients. This chapter presents the anatomical rationale, key indications, and technical steps of eTEP-SA, underscoring its role as a safe, efficient, and reproducible minimally invasive option, even in the context of complex ventral hernia repair. Particular attention is given to its variant, eTEP-SA2, which extends the applicability of this approach to patients with a history of lower abdominal surgery or to those presenting with midline defects associated with inguinal hernias. Finally, the chapter reviews clinical outcomes reported to date, critically analyzing the advantages and limitations of eTEP-SA. Key technical pearls and practical recommendations are highlighted, situating this approach within the broader landscape of innovation in abdominal wall surgery.