Systematic review and meta-analysis comparing ventral hernia repair using minimally-invasive extended totally extraperitoneal repair versus intraperitoneal onlay mesh repair.

Background: This systematic review and meta-analysis analysed was set up to compare totally extraperitoneal mesh repair (TEP) and intraperitoneal onlay mesh placement (IPOM) in patients undergoing minimally invasive ventral hernia mesh surgery (MIS-VHMS).

Methods: A systematic literature searches of three major databases were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to identify studies that compared two techniques of MIS-VHMS: TEP and IPOM. Primary outcome of interest was major complications post-operatively, defined as a composite outcome of surgical-site occurrences requiring procedural intervention (SSOPI), readmission to hospital, recurrence, reoperation or death. Secondary outcomes were intraoperative complications, duration of surgery, surgical site occurrence (SSO), SSOPI, postoperative ileus, post-operative pain. The risk of bias was assessed using Cohranes Risk of Bias tool 2 for randomized controlled trials (RCTs) and Newcastle-Ottawa score for observational studies (OSs).

Results: Five OSs and two RCTs al including total number of 553 patients were included. There was no difference in primary outcome (RD 0.00 [-0.05, 0.06], p=0.95), incidence of postoperative ileus. Operative time was longer in TEP (MD 40.10 [27.28, 52.91], p<0.01). TEP was found to be associated with less postoperative pain at 24h and 7days after surgery.

Conclusions: Both TEP and IPOM were detected to have equal safety profile and do not differ in SSO or SSOPI rates, incidence of postoperative ileus. TEP has longer operative time but provides better early postoperative pain outcomes. Further high-quality studies with long follow up evaluating recurrence and patient reported outcomes are needed. Comparison of other transabdominal and extraperitoneal MIS-VHMS techniques is another direction of future research. PROSPERO registration: CRD4202121099.