LAPAROSCOPIC ENHANCED-VIEW TOTALLY EXTRAPERITONEAL (ETEP) VERSUS INTRAPERITONEAL ONLAY MESH PLUS (IPOM PLUS) REPAIR FOR VENTRAL HERNIA: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Background: Intraperitoneal onlay mesh plus (IPOM Plus) has long been the standard laparoscopic approach for ventral hernia repair, but concerns about intraperitoneal mesh contact have driven adoption of the enhanced-view totally extraperitoneal (eTEP) technique, which restores the retromuscular plane. Comparative evidence remains scattered across small single-centre series. Objective: To systematically review and synthesise comparative evidence on eTEP versus IPOM Plus repair for ventral hernia, incorporating a new retrospective comparative cohort from a tertiary teaching hospital. Methods: Following PRISMA 2020 guidance, PubMed/MEDLINE, Scopus, Cochrane Library and Google Scholar were searched for comparative studies (January 2018 to July 2026) reporting outcomes of eTEP versus IPOM/IPOM Plus repair for primary or incisional ventral hernia. Operative time, postoperative pain, hospital stay, return to activity, complications, recurrence and cost were extracted. Risk of bias was assessed with the Newcastle-Ottawa Scale for cohort studies and Cochrane RoB2 for randomised trials. Quantitative pooling was performed where comparable effect data were available; otherwise a structured narrative (vote-counting) synthesis was used. Results: Eight non-randomised comparative studies (including the present institutional cohort) comprising approximately 610 patients met eligibility criteria. eTEP consistently required a longer operative time than IPOM Plus across all studies reporting this outcome (differences ranging from roughly 35 to 100 minutes). eTEP was associated with lower postoperative pain scores in 7 of 8 studies, shorter hospital stay in 7 of 8 studies, and a lower or comparable postoperative complication rate in all studies reporting complications. Recurrence at available follow-up (6-24 months) was low and did not differ meaningfully between techniques. In the present cohort, eTEP showed significantly shorter hospital stay (3±1 vs 5±1 days), lower VAS pain scores, earlier return to work (10±2 vs 16±2 days) and lower cost (₹35,000 vs ₹70,000), at the expense of longer operative time (168±17 vs 66±14 minutes). Conclusion: Across the pooled evidence, eTEP repair for ventral hernia offers superior early postoperative recovery, less pain and shorter hospitalisation compared with IPOM Plus, at the cost of a longer, more technically demanding operation with a recognised learning curve. Recurrence outcomes appear equivalent in the short to medium term. Adequately powered randomised trials with longer follow-up are needed to confirm durability of these benefits.