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Patients complained pain only in the first postoperative hours. All patients perceived excellent cosmetic results even at postoperative day 1. CONCLUSION H-TOETSA was feasible and resulted to have some technical and clinical advantages maintaining the purpose to avoid a visible scar on the neck.BACKGROUND Up to now the totally extraperitoneal (TEP) technique is limited to the treatment of inguinal hernias. Applying this anatomical repair concept to the treatment of other abdominal wall hernias, we developed an endoscopic totally extraper