Long-term outcomes of IPOM plus and eTEP Rives-Stoppa techniques for midline incisional ventral hernias.

Abstract

<h4>Background</h4>Incisional ventral hernia repair remains important and one of the most complex problems in abdominal wall reconstruction surgery. Introduction of extended-view totally extraperitoneal (eTEP) approach changed significantly the concept of incisional ventral hernia repair. However, long-term results for the eTEP Rives-Stoppa (eTEP RS) remains under-investigated. This study aimed to evaluate the long-term outcomes of IPOM plus and eTEP RS techniques for midline incisional ventral hernias based on CT scan data and quality-of-life (QoL) assessment.<h4>Materials and methods</h4>A single-center, retrospective cohort study was conducted based on data from 117 patients with midline incisional ventral hernias who underwent either IPOM plus (n = 42), or eTEP RS (n = 75) from March 2018 to December 2022. Long-term outcomes were assessed by physical examination and CT scans at rest and during the Valsalva maneuver with a follow-up of more than one and half year. QoL was assessed using the Carolinas Comfort Scale (CCS) and the EuraHS quality-of-life score (EuraHS-QoL).<h4>Results</h4>Early postoperative complications were comparable; a larger mesh size was used in the eTEP RS group (p < 0.001). Long-term outcomes, assessed in 80 (68.4%) patients, demonstrated a significantly lower hernia recurrence rate in the eTEP RS group (2% vs. 19.3%, p = 0.012). A normal postoperative CT scan (without postoperative abdominal wall changes) was confirmed in 89.8% of eTEP RS patients and 58.1% in the IPOM plus group (p = 0.0009). Both the CCS and EuraHS-QoL scores were significantly better in the eTEP RS group (p < 0.05). Patients with normal CT scans had better results of QoL comparing with those who had recurrence, posterior rectus sheath (PRS) rupture or bulging.<h4>Conclusion</h4>Long-term follow-up demonstrates less hernia recurrence rate and higher QoL for eTEP RS in comparison with IPOM plus procedure for midline incisional ventral hernia repair that does not require separation of components. Bulging should be considered as a significant adverse event along with recurrence, since both are associated with a deterioration in the QoL. Prospective trials are needed to determine the optimal technique of minimally invasive procedure for midline ventral hernia repair.