Comparison of laparoscopic intraperitoneal onlay mesh (IPOM Plus) and extended totally extraperitoneal (eTEP RS) repair for incisional hernia - a randomized clinical trial.

BACKGROUND: Laparoscopic intraperitoneal onlay mesh repair with a combination of hernial defect closure (IPOM plus) is an effective and common surgical procedure performed in patients with incisional ventral hernia. The introduction of extended-view totally extraperitoneal Rives-Stoppa procedure (eTEP RS) has sparked debate among surgeons regarding the optimal technique for ventral hernia repair. Our randomized clinical study aims to compare IPOM plus and eTEP RS techniques in patients with midline incisional ventral hernias. METHODS: This is a prospective, single-center, single-blind randomized clinical trial, that was conducted at Moscow City Hospital №1 (Pirogov Russian National Research Medical University's Faculty Clinic) from February 2023 to April 2025. Patients were randomly allocated in a 1:1 ratio to either the eTEP RS group (Group I) or the IPOM plus group (Group II). The primary endpoint of this study was the level of pain on the first postoperative day, measured using the numerical pain scale (NRS-11). The secondary endpoints included the level of pain after 6 ± 1 h, on the 7 (± 1), 30 (± 3) and 100 (± 5) days after surgery, length of stay, postoperative analgesic consumption, short-term complications rate and the presence of chronic pain. RESULTS: 72 patients were allocated equally to eTEP RS (n = 36) and IPOM plus (n = 36) groups. The average pain score on the first postoperative day in the IPOM plus group was significantly higher compared with eTEP RS group (p < 0.001). Comparison of median NRS-11 scores showed significantly lower pain in the eTEP RS group at 6 ± 1 h (p < 0.001), on 7 ± 1 days (p < 0.001), and 30 ± 3 days (p = 0.005). Chronic pain was observed more often in patients who underwent IPOM plus (38.9%, n = 14) than eTEP RS (5.6%, n = 2), p < 0.001. We found no differences in early complications (p = 0.260) and length of stay (p = 0.421). CONCLUSIONS: Patients undergoing eTEP RS repair for midline incisional ventral hernias experienced less frequent pain and lower analgesic requirements in the early postoperative period, as well as a lower rate of chronic pain. TRIAL REGISTRATION: NCT05528107 (http//www. CLINICALTRIALS: gov).