Intraperitoneal Onlay Mesh Plus Repair Versus Transabdominal Preperitoneal Mesh Plus Repair in Patients with Primary...

Area of Science:

• Laparoscopic surgery
• Hernia repair
• Surgical outcomes

Background:

• Ventral hernia repair commonly uses laparoscopic intraperitoneal onlay mesh (IPOM Plus), but it's linked to pain and mesh complications.
• Transabdominal preperitoneal mesh repair (vTAPP Plus) is an extraperitoneal alternative potentially reducing pain and complications.
• Limited high-quality randomized trials directly compare IPOM Plus and vTAPP Plus.

Purpose of the Study:

• To compare the efficacy and safety of laparoscopic IPOM Plus versus vTAPP Plus for ventral hernia repair.
• To evaluate postoperative pain, operative duration, hospital stay, complications, and recurrence rates between the two techniques.

Main Methods:

• A prospective, single-center randomized controlled trial involving 68 adult patients with small-to-medium primary ventral hernias.
• Patients were randomized to either laparoscopic IPOM Plus or vTAPP Plus repair.
• Primary outcome was postoperative pain (Visual Analogue Scale) within 24 hours; secondary outcomes included pain up to 6 months, operative time, hospital stay, complications, and recurrence.

Main Results:

• vTAPP Plus showed significantly lower postoperative pain scores at multiple early and intermediate time points (6, 12, 24, 48 hours, and 14, 30 days; P < .001).
• Hospital stay was significantly shorter with vTAPP Plus, though operative time was marginally longer.
• Postoperative complication rates, mesh infection, and hernia recurrence were comparable between the groups during follow-up.

Conclusions:

• vTAPP Plus repair significantly reduces early and intermediate postoperative pain compared to IPOM Plus.
• The vTAPP Plus technique demonstrates comparable safety and short-term efficacy to IPOM Plus.
• vTAPP Plus is a favorable option for selected primary midline ventral hernias.