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Related Experiment Video

Updated: Jan 14, 2026

Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair
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Comparative Study Between Extended-View Totally Extraperitoneal Rives-Stoppa Repair and Intraperitoneal Onlay Mesh

Kavita Sijwali1, Sanjay Kala1, Ramendra K Jauhari1

  • 1General Surgery, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, IND.

Cureus
|October 22, 2025
PubMed
Summary

The extended totally extraperitoneal Rives-Stoppa (e-TEP RS) approach for ventral hernia repair shows better patient outcomes, including less pain and faster recovery, compared to the intraperitoneal onlay mesh plus (IPOM Plus) technique. Despite a longer operative time, e-TEP RS offers significant advantages for appropriate surgical candidates.

Keywords:
anterior abdominal wall reconstructione-tep rsintraperitoneal onlay mesh repair (ipom) plusminimally invasive surgeryventral and incisional hernia

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Area of Science:

  • Surgical Innovation
  • Abdominal Wall Reconstruction
  • Minimally Invasive Surgery

Background:

  • Ventral hernias are common surgical defects, often treated laparoscopically.
  • The intraperitoneal onlay mesh plus (IPOM Plus) technique is standard, but the extended totally extraperitoneal Rives-Stoppa (e-TEP RS) approach offers potential benefits.
  • Comparing e-TEP RS and IPOM Plus is crucial for optimizing ventral hernia repair.

Purpose of the Study:

  • To prospectively compare the e-TEP RS and IPOM Plus techniques for ventral hernia repair.
  • To evaluate operative parameters, complications, and patient-reported outcomes between the two laparoscopic approaches.

Main Methods:

  • A prospective randomized controlled trial involving 174 patients with ventral hernias.
  • Patients were randomized into e-TEP RS (n=87) or IPOM Plus (n=87) groups.
  • Outcomes included operative time, pain (VAS), hospital stay, return to activity, complications, and quality of life over six months.

Main Results:

  • e-TEP RS had longer operative time (170.2 vs 90.7 min) but significantly lower postoperative and chronic pain, shorter hospital stay (1.8 vs 3.2 days), and earlier return to activity (4.8 vs 7.5 days).
  • Quality of life was significantly better at 3 and 6 months post-surgery for e-TEP RS.
  • Peritoneal breach occurred in e-TEP RS (10.3%), while significant bleeding (>50 mL) was more frequent in IPOM Plus (20.7%). Recurrence, SSI, and seroma rates were lower in e-TEP RS but not statistically significant.

Conclusions:

  • The e-TEP RS technique demonstrates superior postoperative outcomes and quality of life compared to IPOM Plus for ventral hernia repair.
  • Despite a longer operative time, e-TEP RS may be the preferred approach for suitable surgical candidates.
  • IPOM Plus remains a viable alternative when extraperitoneal dissection is not feasible.