Comparison of extended totally extra peritoneal (eTEP) vs intra peritoneal onlay mesh (IPOM) repair for management of primary and incisional hernia in terms of early outcomes and cost effectiveness—a randomized controlled trial

Jain, Mayank; Krishna, Asuri; Prakash, Om; Kumar, Subodh; Sagar, Rajesh; Ramachandran, Rashmi; Bansal, Virinder Kumar

doi:10.1007/s00464-022-09180-3

Cited by 23 publications

(8 citation statements)

References 27 publications

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“…8,17,25,26 The first randomized controlled trial (RCT) in 2022 comparing eTEP (30) and IPOM (30) for ventral hernia showed that the former was more cost-effective and associated with lower seroma rates, postoperative pain scores, and earlier return to activity. 27 In 2023, another RCT (29 eTEP vs. 27 IPOM) also showed lower postoperative pain scores with eTEP but was associated with higher surgeons' workload. 28 A systematic review and metaanalysis comparing eTEP and IPOM (a total of 433 patients) showed longer operative duration, lower postoperative pain scores, and shorter hospital stay in the eTEP group.…”

Section: Discussionmentioning

confidence: 99%

“…The first randomized controlled trial (RCT) in 2022 comparing eTEP (30) and IPOM (30) for ventral hernia showed that the former was more cost‐effective and associated with lower seroma rates, postoperative pain scores, and earlier return to activity 27 . In 2023, another RCT (29 eTEP vs. 27 IPOM) also showed lower postoperative pain scores with eTEP but was associated with higher surgeons' workload 28 .…”

Section: Discussionmentioning

confidence: 99%

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Outcomes after ventral hernia repair using the extended totally extraperitoneal approach: Initial experience from the Philippines

Yap,

Buenafe,

Bejasa

et al. 2024

Asian J Endoscop Surgery

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IntroductionNewer extraperitoneal techniques of laparoscopic ventral/incisional hernia repair (LVIHR) have been continually introduced since the popularity of the laparoscopic intraperitoneal onlay mesh technique began in 1993. One of which is the extended totally extraperitoneal (eTEP) approach allowing wide mesh augmentation, concurrent repair of diastasis recti, and performance of transversus abdominis release (TAR) for large/complex hernias. However, minimally invasive/laparoendoscopic ventral hernia repair is not yet widely adopted in the Philippines. We aim to share our preliminary experience with LVIHR using the eTEP approach.MethodsThis was a retrospective review of all consecutive eTEP repairs for ventral hernia between January 2019 and September 2023. The clinical profiles of all patients were gathered. Hernia characteristics, operative profile, and postoperative outcomes were reported.ResultsThirty‐five patients were included in the study with a mean age of 54.7; 60% were incisional hernias, and the most common hernia location was the umbilical area. A defect size between 4 and 10 cm was reported in 54.3%. eTEP‐TAR was necessary in 12 patients. At a median follow‐up of 16 months, two patients developed seroma, one hematoma, and two surgical site infections. All were successfully managed conservatively. Only one patient developed recurrence.ConclusioneTEP approach is safe and feasible for repairing ventral hernias. Our preliminary experience showed acceptable outcomes similar to the published literature. Surgeons interested in this technique should be familiar with the abdominal wall anatomy, carefully select patients during preoperative planning, and undergo mentorship with hernia surgeons experienced with the technique to shorten the learning curve.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Outcomes after ventral hernia repair using the extended totally extraperitoneal approach: Initial experience from the Philippines

Yap,

Buenafe,

Bejasa

et al. 2024

Asian J Endoscop Surgery

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“…This technique can be performed laparoscopically and allows a surgeon to place a large flat synthetic mesh in the retrorectus plane. When comparing IPOM and eTEP, the latter is better in terms of less early postoperative pain and earlier return to activities [ 26 ]. Therefore, we considered that eTEP would be the best method for VHR after MBS.…”

Section: Discussionmentioning

confidence: 99%

Ventral hernia repair with enhanced-view totally extraperitoneal technique after a massive weight loss by laparoscopic sleeve gastrectomy

et al. 2023

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Background Ventral hernia repair (VHR) for obese patients is often associated with an increased risk of postoperative complications and hernia recurrences. Achieving preoperative weight loss is ideal before VHR; however, it is difficult to attain with medical treatment. Metabolic and bariatric surgery (MBS) offers the most effective and durable treatment for obesity. Therefore, massive weight loss occurring after MBS will improve the outcome of VHR. Case presentation A 49-year-old man (122.9 kg, BMI 39.1 kg/m2) presented to our hospital wishing to undergo laparoscopic sleeve gastrectomy and VHR. Physical examination revealed a tennis ball-sized lower midline defect. Computed tomography (CT) scans revealed a hernia orifice 5 cm in width and 10 cm in height. As the hernia orifice was large, mesh reinforcement was essential. We planned for him to undergo VHR after massive weight loss was achieved by MBS. VHR was performed using the enhanced-view totally extraperitoneal (eTEP) technique after weight loss of 38 kg was achieved 9 months following laparoscopic sleeve gastrectomy. His postoperative course was uneventful, and neither recurrence nor seroma was observed at 1 year follow-up. Conclusions eTEP repair of a ventral hernia after massive weight loss following MBS would appear to be the best combination treatment for obese patients with ventral hernias. However, long-term follow-up is necessary to establish its safety and efficacy.

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“…Zusätzlich zeigt sich bei den Patienten durch traumatische Netzfixierung an der Bauchdecke eine erhöhte Rate akuter und chronischer Schmerzen [ 10 ]. Zudem sind beschichtete Netze und Einmalgeräte zur deren Fixierung (Tacker) ein erheblicher Kostenfaktor [ 11 ].…”

Section: Synopse Der Operationsverfahrenunclassified

Incisional hernias: minimally invasive surgical procedures

Baur,

Meir

2023

Chirurgie

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Zusammenfassung Hintergrund In den letzten Jahren wurde eine Vielzahl neuer Operationstechniken zur minimalinvasiven Versorgung ventraler Hernien entwickelt und vorgestellt. In dieser Übersichtsarbeit werden diese minimalinvasiven Operationstechniken wie eTEP („extended totally extraperitoneal“), MILOS („mini or less open sublay“), ELAR (endoskopisch assistierte Linea-alba-Rekonstruktion), ventrale TAPP (transabdominelle präperitoneale Patch-Technik), IPOM (intraperitoneales Onlay-Mesh) Plus und LIRA (laparoskopische intrakorporale Rektusaponeuroplastie) vorgestellt und die hierzu relevanten bislang publizierten Ergebnisse präsentiert. Ergebnisse Moderne minimalinvasive Techniken zur Behandlung ventraler Hernien bergen das Potenzial einer Reduktion von Wundinfektionen, geringerer postoperativer Schmerzen und einer kürzeren Krankenhausverweildauer im Vergleich zu den klassischen Hernienoperationen. Insbesondere Techniken mit retromuskulärer Netzposition sind aufgrund der Präparation in engen Räumen und aufgrund schwierig durchzuführender endoskopischer Nähte technisch anspruchsvoll und erfordern fundierte Kenntnisse der Anatomie der Bauchwand. Vor allem die Versorgung größerer Hernien sollte daher nur unter der Voraussetzung ausreichender Erfahrung und Fallzahl erfolgen. Schlussfolgerung Die neuen, endoskopischen bzw. endoskopisch assistieren Verfahren zur Versorgung ventraler Hernien ermöglichen dem laparoskopisch erfahrenen Chirurgen, primäre und sekundäre ventrale Hernien minimal-invasiv zu versorgen.

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Comparison of extended totally extra peritoneal (eTEP) vs intra peritoneal onlay mesh (IPOM) repair for management of primary and incisional hernia in terms of early outcomes and cost effectiveness—a randomized controlled trial

Cited by 23 publications

References 27 publications

Outcomes after ventral hernia repair using the extended totally extraperitoneal approach: Initial experience from the Philippines

Outcomes after ventral hernia repair using the extended totally extraperitoneal approach: Initial experience from the Philippines

Ventral hernia repair with enhanced-view totally extraperitoneal technique after a massive weight loss by laparoscopic sleeve gastrectomy

Incisional hernias: minimally invasive surgical procedures

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