Ventral Hernia; Endoscopic Onlay Repair ENDOR

Endoscopic onlay repair (ENDOR) is a minimally invasive technique for umbilical and epigastric hernia repair in which a working space is created in the subcutaneous plane over the anterior rectus sheath. After careful reduction of the hernia sac contents into the abdominal cavity, the fascial defect is primarily closed under direct vision. A prosthetic mesh is then placed over the anterior rectus fascia in the same anatomical plane as a conventional open onlay repair, but through a laparoscopic or endoscopic approach. This method preserves the integrity of the peritoneal cavity and avoids intraperitoneal mesh placement, unlike IPOM. By preventing direct contact between mesh and intra-abdominal viscera, it reduces the risk of adhesions and potential bowel-related complications. Compared with open onlay repair, the endoscopic approach offers smaller incisions, improved cosmetic results, and potentially lower wound infection rates. The technique also allows wide mesh overlap with adequate fixation while maintaining the benefits of minimally invasive surgery. Overall, ENDOR combines the anatomical simplicity of onlay reinforcement with the reduced morbidity associated with laparoscopic surgery.