Comparison of extended view totally extraperitoneal with intraperitoneal onlay mesh for primary ventral hernia surgery: A randomised controlled study from a tertiary university hospital.

Introduction: Primary ventral hernia remains a common presentation in surgical clinics with reported recurrence rates of 10%-20%. Intraperitoneal onlay mesh (IPOM) repair has been the widely accepted technique for laparoscopic management of ventral hernia. More recently, extended view totally extraperitoneal (eTEP) repair has emerged as a safe procedure in terms of reduced post-operative pain and faster recovery. Studies comparing IPOM with eTEP are limited. The present study was conducted to compare the two surgical techniques in terms of early outcomes in patients presenting with primary ventral hernia.

Patients And Methods: A total of 30 patients with primary ventral hernias with defect size > 2 and up to 6 cm were randomised using computer-generated sequences into two groups. Operative time was used as the primary endpoint. Patients were followed up at 6 months, 1 year and 2 years postoperatively to look for recurrence, chronic pain and any other complications.

Results: Mean operative time in the IPOM group was significantly less than eTEP repair (P < 0.001). Mean pain scores in the eTEP group at discharge, on day 1 and 1 week were significantly lower than corresponding scores in the IPOM group. The mean hospital stay (2.09 ± 0.30 days) in the eTEP group was less than the IPOM group (3.64 ± 1.56 days) (P < 0.001). Return to work was also significantly earlier in eTEP (10.18 ± 1.07 days vs. 13.55 ± 2.16 [P < 0.001]). No recurrence was recorded in 23 of 30 patients followed up till 2 years.

Conclusions: Operative time was significantly longer in the eTEP group, reaffirming the published data. Post-operative pain was significantly lower in patients undergoing the eTEP procedure up to 1 week. Consequently, hospital stay was also reduced and return to work was faster in these patients. Both procedures fared equally in terms of no recurrence with a 77% follow-up at 24 months.