COMPARATIVE STUDY OF LAPAROSCOPIC ETEP VERSUS IPOM PLUS REPAIR FOR PRIMARY VENTRAL HERNIA IN A TERTIARY CARE TEACHING HOSPITAL

Abstract

Introduction: Primary ventral hernias are frequently encountered defects of the anterior abdominal wall and include umbilical, paraumbilical, epigastric, and spigelian varieties. Operative repair is advised to avoid complications such as incarceration and intestinal obstruction. Minimally invasive ventral hernia surgery has become increasingly preferred because it provides faster recovery, reduced postoperative discomfort, and fewer wound-related complications. Intraperitoneal Onlay Mesh Plus (IPOM Plus) repair was the most commonly used laparoscopic method of surgery for primary ventral hernia correction, which  involves closure of the fascial defect followed by placement of a composite mesh within the peritoneal cavity in sublay position. Although technically less difficult , intraperitoneal mesh positioning may be associated with adhesion formation and persistent postoperative pain. Enhanced-view Totally Extraperitoneal (eTEP) repair was developed to facilitate retromuscular mesh placement while preserving normal abdominal wall dynamics. Methodology: A comparative observational study was carried out at a tertiary teaching hospital between January 2021 and December 2025. Hundred patients diagnosed with primary ventral hernia underwent laparoscopic repair and were categorized into two groups: IPOM Plus (50 patients) and eTEP (50 patients). Parameters evaluated included operative duration, postoperative pain, duration of hospitalization, perioperative complications, recurrence, and recovery profile. Results: Patients treated with eTEP experienced lower postoperative pain scores, reduced seroma occurrence, shorter hospital stay, and earlier recovery when compared with the IPOM Plus group. The operative time was longer in the eTEP arm because of the technically demanding retrorectus dissection. Conclusion: eTEP repair demonstrated improved postoperative recovery and lower morbidity in comparison with IPOM Plus repair for primary ventral hernia, despite requiring greater operative expertise.