Comparative evaluation of enhanced total extraperitoneal repair and intraperitoneal onlay mesh repair-plus for ventral hernias: A randomised controlled study.

Introduction: Ventral hernia repair techniques have evolved, with enhanced total extraperitoneal repair (eTEP) and intraperitoneal onlay mesh repair-plus (IPOM+) emerging as alternatives. While eTEP avoids complications such as adhesions and infections associated with intraperitoneal mesh placement, its effectiveness compared to IPOM+ remains debated. To compare the outcomes of eTEP and IPOM+ in primary midline ventral hernia repair, focusing on post-operative pain, complications and early recurrence rates.

Patients and methods: A randomised controlled study was conducted in a tertiary hospital in Delhi from August 2022 to February 2024. Forty-eight patients with primary midline ventral hernias (defect size: 2-6 cm) were randomised into eTEP (n = 24) and IPOM+ (n = 24) groups. Outcomes included operative time, pain scores (evaluated at 6 h, 24 h, 7 days, 1 month and 3 months), analgesic use, complications (seroma and surgical site infections) and recurrence rates.

Results: eTEP had significantly longer operative time (115.83 ± 36.30 min vs. 63.94 ± 10.94 min; P < 0.001) but significantly lower pain scores at 6 and 24 h (P < 0.001). Analgesic requirements were reduced in the eTEP group, with only two patients requiring rescue analgesia compared to 20 in the IPOM+ group (P < 0.001). No significant differences were observed in seroma rates, surgical site infections or recurrence at 3 months.

Conclusions: eTEP offers reduced early post-operative pain and lower analgesic use compared to IPOM+, with similar complication and recurrence rates. Despite longer operative times, eTEP provides a viable alternative for ventral hernia repair with potential quality-of-life benefits.