Perspective Chapter: Endoscopic e-TEP Rives-Stoppa (Enhanced-view Totally ExtraPeritoneal RS)

The endoscopic enhanced-view totally extraperitoneal (e-TEP) Rives-Stoppa technique represents an important evolution in minimally invasive abdominal wall reconstruction. By combining the principles of the open Rives-Stoppa repair with a totally extraperitoneal endoscopic approach, the technique enables layered anatomical reconstruction with placement of a large mesh in the retromuscular plane, isolated from intra-abdominal viscera. This allows both closure of the fascial defect and plication of the , thereby restoring abdominal wall function. E-TEP offers several advantages over intraperitoneal onlay mesh (IPOM), including reduced postoperative pain, lower incidence of seroma, and surgical site infection, thus improving long-term durability. However, the procedure requires advanced laparoscopic skills, presents challenging ergonomics, and is best suited for small- to medium-sized midline hernias, often associated with rectus diastasis. Careful patient selection, supported by preoperative imaging and progressive standardization of the technique, remains essential for safe implementation and reproducible outcomes.