Laparoscopic ventral TAPP versus IPOM for primary umbilical hernia repair: why use a sledgehammer to crack a nut?

Intraperitoneal onlay mesh (IPOM) repair is the most commonly performed minimally invasive technique for ventral hernia repair, however, it is associated with increased postoperative discomfort and longer hospitalization. This study aimed to compare the efficacy and safety of the ventral transabdominal preperitoneal (V-TAPP) procedure and IPOM in primary umbilical hernia repair.

A retrospective review was conducted on 70 adult patients who underwent elective laparoscopic primary umbilical hernia repair between 2019 and 2026, using either the V-TAPP (n = 40) or IPOM (n = 30) technique. Short- and long-term comparative outcome analyses were performed.

Patient demographics, comorbidities and hernia characteristics were similar between the two groups. Surgery duration was significantly shorter in the IPOM group (time in minutes V-TAPP vs. IPOM: 98.1 ± 26.3 vs. 68.4 ± 24.5; p < 0.001). The effect of IPOM with regard to postoperative pain at 24 h was also pronounced (VAS Score min:0 max:10; V-TAPP vs. IPOM: 3 ± 1.3 vs. 4.8 ± 1.4; p < 0.001) Postoperative LOS was significantly longer in the IPOM group (LOS in days V-TAPP vs. IPOM: 1.3 ± 1 vs. 4.8 ± 1.4; p < 0.001). After adjusting for baseline clinical confounders via multivariable regression, the IPOM approach remained a significant independent predictor of both longer hospital stays (B = 2.69, p < 0.05) and higher 24-h postoperative pain (B = 1.81, p < 0.05). All other intra- and perioperative outcomes of interest were similar. No differences were noted at follow-up.

With the exception of a longer operative time, V-TAPP was associated with significant advantages over IPOM in terms of patient recovery, while maintaining comparable safety and efficiency. While these findings are promising, larger prospective studies are warranted to confirm whether V-TAPP should be considered the preferred approach for small- and medium-sized primary umbilical hernias.