Laparoscopic extraperitoneal techniques in ventral hernia repair: a retrospective comparative study of TAPP and TEP

Ventral hernia repair has traditionally been performed laparoscopically using the intraperitoneal onlay mesh (IPOM) technique, which is simple and widely available but carries the drawback of mesh-viscera contact. Extraperitoneal approaches such as transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) repair have emerged as alternatives that avoid this limitation, allowing the use of standard meshes without fixation. However, evidence comparing these techniques remains scarce.

We conducted a retrospective comparative analysis of a prospectively collected database at a single centre between January 2023 and December 2024. Patients undergoing laparoscopic repair of primary ventral or W1 incisional hernias smaller than 4 cm, with or without rectus diastasis, were included. Demographic data, operative details, and postoperative outcomes were recorded. Pain was assessed using the visual analogue scale (VAS). Complications were graded according to Clavien-Dindo. Follow-up was at least 12 (twelve) months for all patients.

Thirty-three patients were analysed, 18 in the TEP group and 15 in the TAPP group. Baseline demographic and comorbidity characteristics were comparable. Operative time was significantly longer for TAPP (96.1 ± 14.8 vs. 84.7 ± 13.1 min, p=0.029). Mesh area was larger in TEP (242.9 ± 110.3 vs. 166.9 ± 49.9 cm², p=0.015). Rectus diastasis was present in a similar proportion of patients (55.6% vs. 53.3%), but correction was achieved only in TEP (11 of 18 cases, 61.1%). There was one conversion to IPOM in TAPP. Postoperative pain scores, hospital stay (18.2 vs. 15.3 h, p=0.119), and 30-day complication rates (13.3% vs. 22.2%, p = 0.665) were comparable, consisting mainly of minor seromas or haematomas. No recurrences were observed at 1 year.

Both TAPP and TEP are safe and effective minimally invasive approaches for small ventral and W1 incisional hernia repair. TAPP is associated with longer operative times due to peritoneal flap creation, while TEP enables broader mesh placement and ergonomic correction of rectus diastasis. Despite the small sample size and retrospective design, our findings add to the growing evidence supporting extraperitoneal approaches as valuable alternatives to IPOM in abdominal wall surgery.