Systemic Stress Biomarkers and Patient-Reported Outcomes Following Laparoscopic IPOM+ and Open Rives-Stoppa Repair...

Introduction: Ventral incisional hernia repair remains a significant surgical challenge, with ongoing debate regarding the optimal approach. While laparoscopic intraperitoneal onlay mesh (IPOM+) and open Rives-Stoppa techniques are widely utilized, a comprehensive understanding integrating perioperative clinical outcomes, patient-reported quality of life, and the systemic stress response is lacking. This study aimed to compare these two surgical techniques across these multifaceted domains. Methods: This prospective non-randomized comparative study enrolled 96 adult patients (n = 48 per group) undergoing elective ventral incisional hernia repair via either laparoscopic IPOM+ or open Rives-Stoppa techniques. Perioperative clinical outcomes (operative time, hospital stay, bowel function, pain, analgesic use, complications, self-reported return to daily activities) and EuraHS-QoL scores were assessed. A comprehensive panel of endocrine (cortisol, ACTH, prolactin), inflammatory (IL-6, CRP, presepsin, procalcitonin), and coagulation (D-dimer) biomarkers were measured preoperatively and on the first postoperative day. Results: Laparoscopic IPOM+ repair was associated with more favorable postoperative recovery compared to open repair, characterized by reduced pain, shorter hospital stay, faster return to daily activities and better patient-reported quality of life (all p < 0.001). No significant time-by-group interactions were observed for endocrine or coagulation markers, indicating comparable perioperative trajectories (p > 0.05), while the inflammatory response (IL-6, C-reactive protein, presepsin, and procalcitonin) differed between the two approaches. Significant time-by-group interactions were found for IL-6 (p = 0.005), C-reactive protein (p = 0.015), presepsin (p = 0.040) and procalcitonin (p = 0.006). These associations remained after adjustment for baseline age, BMI, employment status and ASA classification. However, following Bonferroni's adjustment for multiple comparisons, the observed associations between the biomarkers and the outcome did not remain statistically significant. Conclusions: Laparoscopic IPOM+ was associated with more favorable postoperative recovery and lower one-month EuraHS-QoL scores compared to the open Rives-Stoppa repair. Although some biomarkers suggested a possible difference in the postoperative inflammatory response between the two groups, further studies are needed to determine whether these findings reflect true biological differences between the surgical techniques.