Comparison of endovideosurgical intraperitoneal (IPOM plus) and extraperitoneal retromuscular (eTEP RS) hernioplasties for midline incisional ventral hernias — intermediate results of a randomized controlled trial

Introduction. Treatment of patients with postoperative ventral hernias is an urgent problem in general surgical practice. According to clinical recommendations, there is no single “gold standard” for the treatment of patients with midline incisional ventral hernias.

Purpose of the study. To compare the results of treatment of patients with midline incisional ventral hernias using IPOM plus and eTEP RS.

Materials and methods of the Study. A prospective randomized controlled trial (RCT) was initiated on the basis of N.I. Pirogov State Clinical Hospital No.1. Inclusion criteria: patients of both sexes from 18 years old, presence of midline postoperative hernia, width of hernia defect from 2 to 6 cm inclusive, ASA I-II. The study was performed according to the protocol published on ClinicalTrials.gov after obtaining approval from the hospital ethical committee. The study protocol initially outlined an interim analysis of outcomes after achieving greater than 50 % patient enrollment.

Treatment outcomes. Between February 2023 and April 2024, 45 patients were enrolled in the study: eTEP RS (n=23), IPOM plus (n=22). Pain syndrome at 6 h, 24 h, at discharge and at 7 days was significantly less severe in the eTEP RS group compared to the IPOM plus group (p= 0,0001; p= 0,003; p=˂0,0001, p= 0,0003). Chronic pain syndrome was more frequent in the IPOM plus group n=6 (28,6 %), versus 3 (12,5 %) in the eTEP RS group. Wound complications were more prevalent in the IPOM plus group (7 (31,8 %), p= 0,03), due to the number of seromas.

Conclusion. The interim results show a lower incidence of pain in the postoperative period and a lower incidence of chronic pain syndrome with the eTEP-RS technique.

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