ETEP–RIVES–STOPPA REPAIR IN PRIMARY VENTRAL HERNIA - OUR EXPERIENCE IN A TERTIARY CARE TEACHING HOSPITAL

Abstract

Background: Primary ventral hernias, including umbilical, paraumbilical, epigastric and spigelian hernias are among the most frequently encountered abdominal wall defects in general surgical practice. Although open retromuscular repair remains an established treatment modality, the increasing adoption of minimally invasive techniques has transformed ventral hernia surgery. The Enhanced Totally Extraperitoneal Rives–Stoppa (eTEP-RS) repair allows retromuscular mesh placement through a minimally invasive approach while avoiding direct contact between mesh and intra-abdominal viscera. Despite increasing popularity of this technique, studies exclusively evaluating its outcomes in primary ventral hernias remain limited. Aim-To evaluate the feasibility, safety, and effectiveness of laparoscopic eTEP–Rives–Stoppa repair for the management of primary ventral hernias. Materials and Methods: A retrospective observational study was conducted in the Department of General Surgery at Saveetha Medical College and Hospital, Chennai, a tertiary care teaching hospital in South India, between January 2021 and December 2024. All procedures were performed by a single surgeon experienced in advanced abdominal wall reconstruction. Forty consecutive patients with primary ventral hernias who underwent laparoscopic eTEP-RS repair were included. Demographic characteristics, operative variables, perioperative outcomes, postoperative complications, and recurrence rates were analyzed. Results: Forty patients underwent laparoscopic eTEP–Rives–Stoppa repair for primary ventral hernias. The mean age was 46.8 ± 10.2 years, with a male-to-female ratio of 22:18. The mean operative time was 112 ± 22 minutes, and the mean mesh area was 298 ± 30 cm². Standard eTEP-RS repair was performed in 95% of patients, with TAR required in 5% and hybrid-assisted repair in 7.5%. The mean hospital stay was 2.8 ± 0.9 days, with low postoperative pain (2/10). Seroma occurred in 7.5% of patients, while no mesh infections or recurrences were observed during follow-up. Conclusion: Laparoscopic eTEP–Rives–Stoppa repair is a safe, feasible, and effective technique for the management of primary ventral hernias, including W1 defects, with low postoperative pain, minimal complications, negligible wound related morbidity, and excellent early outcomes without early recurrence. These findings support its role as a reliable and versatile minimally invasive retromuscular repair across the spectrum of primary ventral hernias.