LAPAROSCOPIC ENHANCED-VIEW TOTALLY EXTRAPERITONEAL RIVES–STOPPA (ETEP-RS) REPAIR FOR INCISIONAL HERNIA: A SYSTEMATIC REVIEW AND META ANALYSIS INCORPORATING AN INSTITUTIONAL COHORT

Abstract

Background: Incisional hernia repair is technically demanding because prior surgery distorts tissue planes and reduces the working space available for retromuscular reconstruction. The enhanced-view totally extraperitoneal Rives–Stoppa (eTEP-RS) technique reproduces open retromuscular repair through a minimally invasive extraperitoneal approach, but evidence specific to incisional (rather than mixed primary-and-incisional) defects remains scattered across small single centre series. Objective: To systematically review the available evidence on laparoscopic eTEP-RS for incisional hernia and to contextualise a new 50-patient institutional cohort within that evidence through quantitative synthesis where feasible. Methods: PubMed/MEDLINE, Google Scholar and cross-referenced bibliographies were searched for studies (2018 2026) reporting outcomes of eTEP-RS (with or without transversus abdominis release, TAR) for ventral hernia in which incisional defects formed all or a defined subset of the cohort. Operative time, TAR utilisation, hospital stay, seroma, wound infection, and recurrence were extracted. Because outcome definitions, dispersion measures and follow-up intervals were not uniformly reported, pooling was performed as a simple proportion synthesis (events/total, with Wilson 95% confidence intervals) for outcomes with a consistent binary denominator across at least two studies, and as a narrative/range synthesis otherwise, consistent with Cochrane guidance when formal random-effects meta-analysis is not supportable across a heterogeneous evidence base. Results: Nine primary studies (including the present institutional cohort), together comprising 851 patients undergoing eTEP-RS or eTEP-RS/TAR for ventral hernia, met eligibility criteria; a tenth report was a prior systematic review/meta analysis of the wider eTEP literature and was retained for contextual discussion rather than pooled as primary data. Reported operative times for incisional-hernia-predominant cohorts ranged from approximately 124 minutes (eTEP-RS without TAR) to over 220 minutes (with bilateral TAR), and hospital stay clustered between 3 and 4 days. Pooled across five studies reporting a clear numerator/denominator, recurrence occurred in 13/422 patients (3.1%, 95% CI 1.8–5.2%) over follow-up ranging from short-term to a mean of 51 months. TAR was required in 30.0% of patients pooled across two studies reporting this explicitly (95% CI 24.2–36.5%). Seroma, the most frequently reported complication, occurred in 7.2% of patients pooled across two studies (95% CI 3.1–15.9%), consistent with the 5% pooled seroma rate reported in a prior meta-analysis of the broader eTEP literature (13 studies, 918 patients). No study reported mesh infection. In the present institutional cohort of 50 patients with incisional hernia alone, mean operative time was 180 ± 15 minutes, TAR was required in 40%, mean hospital stay was 4.1 ± 1.2 days, seroma occurred in 8% and wound infection in 4%, with no mesh infection or recurrence identified during follow-up. Conclusion: Across a still-limited but growing evidence base, eTEP-RS appears to be a feasible, reproducible technique for incisional ventral hernia repair, with low reported rates of surgical-site infection and mesh infection and a pooled recurrence rate under 5% at heterogeneous, generally short-to-medium-term follow-up. The technique's disadvantage is a longer, more technically demanding operation, particularly when TAR is required. Evidence remains dominated by retrospective single-centre or single-surgeon series with limited long-term follow-up; adequately powered, incisional hernia-specific comparative studies with standardised outcome reporting and follow-up beyond two years are needed.