The Comparison of eTEP and IPOM in Ventral and Incisional Hernia Repair: A Systematic Review and Meta-analysis

Abstract

Background: Open sublay technique and laparoscopic intraperitoneal onlay mesh (IPOM) technique are the most common used procedures in ventral and incisional hernia repair, however, each technique has its own disadvantages. The enhanced view total extraperitoneal technique (eTEP) aims to put the mesh in the retromuscular space by minimal invasive technique. This study is to investigate the efficacy and safety of eTEP and IPOM approach in ventral and incisional hernia repair.Methods: The major databases (PubMed, Embase, Springer, and Cochrane Library) were searched, and all studies published through May 1, 2021, using the keywords "enhanced view extraperitoneal," "extended view totally extraperitoneal," "eTEP," "TEP," "laparoscopic retromuscular," "ventral hernia," "incisional hernia," "laparoscopic intraperitoneal onlay mesh," "IPOM." All relevant articles and reference lists in these original studies were also obtained from the above databases.Results: Five trials containing 433 patients were included in the present study. Compared with the IPOM technique, the eTEP ventral/incisional hernia repair was associated a longer operative time [mean difference = 44.79; 95% confidence interval (CI): 26.57, 63; P = 0.00001], less acute pain on postoperative day 1 (standardized mean difference = −3.90; 95% CI: −4.42, −3.38; P < 0.00001), and day 7 (standardized mean difference = −3.72; 95% CI: −6.09, 1.35; P = 0.002), and the eTEP group had a shorter hospital stay compared with the IPOM group (mean difference = −0.56; 95% CI: −0.74, −0.39; P = 0.00001). There was no significant difference concerning the incidence of seroma, hematoma, intraoperative complication, and postoperative ileus between eTEP and IPOM groups. Conclusions:The eTEP technique in ventral and incisional hernia repair shows significantly lower acute postoperative pain and shorter hospital study but a longer operative time. In addition, there is no significant difference in terms of intraoperative or postoperative complications. Further randomized controlled studies with long-term follow-up are needed to evaluate the eTEP technique.

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

“…A systematic review and meta‐analysis 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. However, the rates of intraoperative complications and postoperative ileus, seroma, and hematoma were similar 29 …”

“…However, the rates of intraoperative complications and postoperative ileus, seroma, and hematoma were similar. 29 In a systematic review of minimally invasive (laparoscopic/robotic) component separation techniques (CST), posterior CST-TAR showed a lower length of hospital stay (2.4 ± 1.4 vs. 7.2 ± 2.1 days) and recurrence rates (0.4% vs. 6.6%), with no significant difference in surgical complication rates (17.8% vs. 15.8%) when compared with minimally invasive anterior CST. 30 To the best of our knowledge, this is the first report on outcomes after ventral hernia repair in the Philippines, which focused on a MIS approach.…”

Body Mass Index Effect on Minimally Invasive Ventral Hernia Repair: A Systematic Review and Meta-analysis

“…Addo et al 9 reported 461 patients undergoing laparoscopic or robotic retromuscular repairs and found no differences in recurrences or complications when comparing patients with BMI >35 kg/m 2 or <35 kg/m 2 . Although we were unable to perform a subgroup analysis of different surgical techniques, a meta-analysis comparing enhanced total extraperitoneal and IPOM showed no difference in postoperative complications, but this is an area of ongoing research, and a randomized clinical trial is currently ongoing to compare both techniques (NCT04150796) 27 …”

“…Although we were unable to perform a subgroup analysis of different surgical techniques, a meta-analysis comparing enhanced total extraperitoneal and IPOM showed no difference in postoperative complications, but this is an area of ongoing research, and a randomized clinical trial is currently ongoing to compare both techniques (NCT04150796). 27…”

Systematic review of robotic ventral hernia repair with meta‐analysis

“…A systematic review by Li et al (2022) suggested eTEP was associated with reduced LOS, however no significant difference was found in intraoperative and postoperative complications. 53 Recurrence in hernia surgery is an important outcome as it affects quality of life and may require re-operation. The assessment of recurrence in RVHR is limited, as most available studies have follow-up periods of under 1 year, and recurrence often develops following this period.…”