Comparison of laparoscopic intraperitoneal onlay mesh (IPOM Plus) and extended totally extraperitoneal (eTEP RS) repair for incisional hernia - a randomized clinical trial.

IF 2.7 2区医学 Q1 SURGERY

Hernia Pub Date : 2026-09-04 DOI:10.1007/s10029-026-03846-w

Georgy B Ivakhov, Andrey V Andriyashkin, Aleksandra A Kalinina, Deividas Kuzmauskas, Svetlana M Titkova, Vokhidzhon A Mamadumarov, Taras V Nechay, Alexander V Sazhin

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引用次数: 0

Abstract

Background: Laparoscopic intraperitoneal onlay mesh repair with a combination of hernial defect closure (IPOM plus) is an effective and common surgical procedure performed in patients with incisional ventral hernia. The introduction of extended-view totally extraperitoneal Rives-Stoppa procedure (eTEP RS) has sparked debate among surgeons regarding the optimal technique for ventral hernia repair. Our randomized clinical study aims to compare IPOM plus and eTEP RS techniques in patients with midline incisional ventral hernias.

Methods: This is a prospective, single-center, single-blind randomized clinical trial, that was conducted at Moscow City Hospital №1 (Pirogov Russian National Research Medical University's Faculty Clinic) from February 2023 to April 2025. Patients were randomly allocated in a 1:1 ratio to either the eTEP RS group (Group I) or the IPOM plus group (Group II). The primary endpoint of this study was the level of pain on the first postoperative day, measured using the numerical pain scale (NRS-11). The secondary endpoints included the level of pain after 6 ± 1 h, on the 7 (± 1), 30 (± 3) and 100 (± 5) days after surgery, length of stay, postoperative analgesic consumption, short-term complications rate and the presence of chronic pain.

Results: 72 patients were allocated equally to eTEP RS (n = 36) and IPOM plus (n = 36) groups. The average pain score on the first postoperative day in the IPOM plus group was significantly higher compared with eTEP RS group (p < 0.001). Comparison of median NRS-11 scores showed significantly lower pain in the eTEP RS group at 6 ± 1 h (p < 0.001), on 7 ± 1 days (p < 0.001), and 30 ± 3 days (p = 0.005). Chronic pain was observed more often in patients who underwent IPOM plus (38.9%, n = 14) than eTEP RS (5.6%, n = 2), p < 0.001. We found no differences in early complications (p = 0.260) and length of stay (p = 0.421).

Conclusions: Patients undergoing eTEP RS repair for midline incisional ventral hernias experienced less frequent pain and lower analgesic requirements in the early postoperative period, as well as a lower rate of chronic pain.

Trial registration: NCT05528107 (http//www.

Clinicaltrials: gov).

查看原文本刊更多论文

腹腔镜腹膜内补片（IPOM Plus）和扩展全腹膜外补片（eTEP RS）修复切口疝的随机临床试验比较

背景：腹腔镜腹膜内补片修补术联合疝缺损修补术（IPOM +）是治疗切口腹疝的一种有效且常见的手术方法。大视场全腹膜外Rives-Stoppa手术（eTEP RS）的引入引发了外科医生关于腹疝修复最佳技术的争论。我们的随机临床研究旨在比较IPOM +和eTEP RS技术在中线切口腹疝患者中的应用。方法：这是一项前瞻性、单中心、单盲随机临床试验，于2023年2月至2025年4月在莫斯科市第一医院（Pirogov俄罗斯国立研究医科大学院系诊所）进行。患者按1:1的比例随机分配到eTEP RS组（I组）或IPOM +组（II组）。本研究的主要终点是术后第一天的疼痛水平，采用数值疼痛量表（NRS-11）测量。次要终点包括术后6±1小时、术后7（±1）、30（±3）和100（±5）天的疼痛程度、住院时间、术后镇痛药用量、短期并发症发生率和是否存在慢性疼痛。结果：72例患者平均分为eTEP RS组（n = 36）和IPOM +组（n = 36）。IPOM +组术后第1天的平均疼痛评分明显高于eTEP RS组(p)。结论：接受eTEP RS修复中线切口腹疝的患者术后早期疼痛发生率较低，镇痛需求较低，慢性疼痛发生率较低。试验注册：NCT05528107 （http://www.Clinicaltrials: gov）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hernia SURGERY-

CiteScore

4.90

自引率

26.10%

发文量

171

审稿时长

4-8 weeks

期刊介绍： Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery. Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.