Comparison of Minimally Invasive Retromuscular Repair Using the Enhanced-View Totally Extraperitoneal (eTEP) Approach vs. Intraperitoneal Onlay Mesh (IPOM) in Ventral Hernia Repair

Yaninee Anusitviwat^1,2*Siripong Chewathanakornkul¹Kamthorn Yolsuriyanwong¹Somrit Mahattanobon¹Suphawat Laohawiriyakamol¹Piyanun Wangkulangkul^1*

• ¹Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
• ²Department of Surgery, Faculty of medicine, Burapha university, Chonburi, Thailand

The laparoscopic intraperitoneal onlay mesh (IPOM) technique has been widely used for ventral hernia repair; however, concerns regarding mesh-related complications have led to the development of alternative approaches. The enhanced-view totally extraperitoneal (eTEP) technique has emerged as a promising alternative, offering improved anatomical restoration and reduced postoperative morbidity. This study compares the clinical outcomes of eTEP and IPOM for ventral hernia repair.Methods: A retrospective cohort study was conducted at a tertiary referral centre in Thailand. Patients who underwent laparoscopic ventral hernia repair using either eTEP or IPOM between January 2016 and December 2021 were included. Demographic data, hernia characteristics, perioperative variables, and postoperative outcomes were analysed. Statistical comparisons were performed using parametric and nonparametric tests, with a significance threshold of p < 0.05.Results: A total of 70 patients were included, with 32 undergoing eTEP and 38 undergoing IPOM. Both groups were comparable in baseline characteristics, with most cases classified as incisional hernias. The mean operative time was significantly longer in the eTEP group (360 vs. 240 minutes, p < 0.001).Subgroup analysis showed significantly lower postoperative pain scores at 12 and 24 hours in the eTEP-RS and eTEP-TAR groups compared to the IPOM group (p < 0.001). The mean VAS scores at 12 hours were 4 (eTEP-RS), 3 (eTEP-TAR), and 7.5 (IPOM), while at 24 hours, they decreased to 2 (eTEP-RS), 2 (eTEP-TAR), and 4 (IPOM). Complication rates were comparable between groups; however, minor bowel injury was reported in some IPOM cases. The one-year recurrence rate was 3.1% for eTEP and 7.9% for IPOM (p=0.620) , increasing to 6.2% and 15.8% at two years, respectively (p=0.275).Laparoscopic eTEP is a safe and effective alternative to IPOM for medium to large ventral hernias, demonstrating lower postoperative pain and recurrence rates. However, its technical complexity and longer operative time highlight the importance of careful patient selection and surgical expertise.Further prospective studies with larger sample sizes are needed to validate these findings and optimise clinical outcomes.