# Comparative Study Between Extended-View Totally Extraperitoneal Rives–Stoppa Repair and Intraperitoneal Onlay Mesh Plus Repair for Ventral Abdominal Wall Hernias: A Randomized Controlled Trial

## TL;DR

This study compares two laparoscopic hernia repair techniques, finding that one offers better recovery and less pain despite longer surgery time.

## Contribution

A randomized controlled trial comparing e-TEP RS and IPOM Plus for ventral hernia repair with detailed outcomes on pain, recovery, and complications.

## Key findings

- e-TEP RS had longer operative time but lower postoperative and chronic pain scores.
- e-TEP RS showed shorter hospital stays and faster return to activity compared to IPOM Plus.
- IPOM Plus had higher bleeding rates, while e-TEP RS had more peritoneal breaches but lower recurrence rates.

## Abstract

Introduction

Ventral hernias are among the most common abdominal wall defects encountered in surgical practice and are increasingly managed laparoscopically due to lower postoperative morbidity and faster recovery times. While the intraperitoneal onlay mesh plus (IPOM Plus) technique is widely practiced, the extended totally extraperitoneal Rives-Stoppa (e-TEP RS) approach enables extraperitoneal mesh placement and may offer improved outcomes. This study aims to compare the two techniques regarding operative parameters, complications, and patient-reported outcomes.

Methods

A prospective randomized controlled trial was conducted at Ganesh Shanker Vidyarthi Mandir (GSVM) Medical College, Kanpur, from February 2024 to April 2025. A total of 174 patients with primary or incisional ventral hernias were randomized into two groups: e-TEP RS (n = 87) and IPOM Plus (n = 87). Outcomes assessed included operative time, pain using Visual Analogue Scale (VAS) scores, hospital stay, return to activity, complications (seroma, hematoma, surgical site infections, and recurrence), chronic pain, quality of life, and conversion rate over six months. This study was registered on ClinicalTrial.gov with the identifier NCT07055464.

Results

The e-TEP RS group had a significantly longer operative time (170.2 ± 14.0 min vs. 90.7 ± 9.9 min; p < 0.001) but demonstrated lower postoperative and chronic pain scores (p < 0.001), shorter hospital stay (1.8 ± 0.6 days (n = 87) vs. 3.2 ± 1.1 days; p < 0.001), and earlier return to activity (4.8 ± 1.2 days vs. 7.5 ± 2.0 days; p < 0.001). Quality of life at three and six months was significantly better (p < 0.001).Peritoneal breach occurred only in e-TEP RS (nine cases, 10.3%), while bleeding > 50 mL was more frequent in IPOM Plus (18 cases, 20.7% vs. six cases, 6.9%; p = 0.014). Recurrence, surgical site infection, and seroma rates were lower in e-TEP RS but not statistically significant. Conversion to IPOM Plus was needed in two e-TEP RS cases (2.3%) due to intraoperative challenges.

Conclusion

Despite longer operative time, the e-TEP RS technique demonstrated superior postoperative outcomes and may be preferred in appropriate surgical candidates. The IPOM Plus technique remains a viable alternative in cases where extraperitoneal dissection is not feasible.