IPOM versus eTEP as minimally invasive approaches for ventral/incisional hernias: a systematic review and meta-analysis

Abstract

PURPOSE: Enhanced-view totally extraperitoneal (eTEP) repair of ventral hernias is an emerging modality that places synthetic mesh in the retrorectus space and obviates its fixation. We aimed to compare outcomes between eTEP and minimally invasive intraperitoneal onlay mesh (IPOM) repair techniques. METHODS: A PRISMA-compliant meta-analysis searching PubMed, EMBASE and CENTRAL databases from January 2010 till August 2024, was performed. All studies comparing IPOM versus eTEP were included. The primary objective was postoperative pain at day 7 (POD7) whereas secondary objectives included operative time, length of stay (LOS), intraoperative and postoperative complications and recurrence. Random effects models were used to calculate pooled effect size estimates. Sensitivity analyses were also performed. RESULTS: Twelve studies (3 randomized, 9 observational) capturing 868 patients (452 IPOM, 416 eTEP) were included. Most hernias were primary ventral (n = 806). Most studies (10/12) adopted a laparoscopic approach whilst two employed robotic techniques. IPOM was associated with significantly higher pain scores at POD7 (VAS; visual analog scale; MD 3.01, 95%CI = 1.28-4.75, p = 0.0007), longer LOS (MD 0.65 days, 95%CI = 0.27-1.04, p = 0.001) but shorter operative time (MD - 53.69 min, 95%CI = - 69.65- - 37.73, p < 0.00001). However, there was no differences in intraoperative (OR 2.04, 95%CI = 0.81-5.17, p = 0.13), postoperative (OR 1.15, 95%CI = 0.54-2.46, p = 0.72) complications or recurrence (OR 2.08, 95%CI = 0.79-5.46, p = 0.14). On sensitivity analyses, comparing laparoscopic IPOM with defect closure (IPOM +) versus eTEP, similar results prevailed. CONCLUSIONS: IPOM(+) is associated with more postoperative pain at one week and a longer hospital stay. However, no differences were observed in complications or recurrence between the two techniques.