Comparison of laparoscopic intraperitoneal onlay mesh (IPOM Plus) and extended totally extraperitoneal (eTEP RS) repair for incisional hernia - a randomized clinical trial.

TL;DR

Randomized trial comparing laparoscopic IPOM plus and eTEP RS repair for incisional ventral hernias found eTEP RS associated with significantly lower pain scores acutely and at 30 days, plus substantially lower chronic pain rates (5.6% vs 38.9%). Early complications and length of stay were similar between groups.

Key findings

• eTEP RS produced lower pain on postoperative day 1 and at 6 hours, 7 days, and 30 days compared to IPOM plus
• Chronic pain developed in 38.9% of IPOM plus patients versus only 5.6% of eTEP RS patients (p < 0.001)
• Early complication rates and hospital length of stay were equivalent between the two techniques
• Analgesic consumption was reduced in the eTEP RS group during early postoperative recovery

Why this matters at the bedside

Findings support eTEP RS as a preferred approach for midline incisional hernia repair when pain reduction and chronic pain prevention are clinical priorities, despite both techniques being effective in terms of early morbidity and hospital stay.