COMPARISON BETWEEN ENHANCED VIEW TOTAL EXTRA-PERITONEAL RETRO-MUSCULAR (ETEP) APPROACH VERSUS INTRAPERITONEAL ONLAY MESH (IPOM) FOR VENTRAL HERNIA REPAIR
Main Article Content
Keywords
IPOM, eTEP, VAS score, recurrence, postoperative pain
Abstract
Background: Ventral abdominal hernia repair is frequent for general surgeons. IPOM commonly places mesh intra-abdominally. Modern procedures such extended extra-peritoneal retro-muscular approach (eTEP) have advantages over intra-peritoneal onlay mesh. Using post-operative discomfort, surgical site infection risk, and hospital stay, this research compares these two treatments.
Study design: randomized controlled trial
Study place and duration: Department of Surgical Unit-I, Chaudhry Muhammad Akram Teaching & Research Hospital , Azra Naheed Medical College , Lahore (From Nov 2023 to Oct 2024)
Patients and Methods: 49 ventral hernia patients were randomised into IPOM and eTEP repair groups of 24 and 25. Patients were monitored for discomfort, wound infection, hospital stay, and hernia recurrence after surgery. All data was recorded and analysed with SPSS 26.
Results: Mean age of the patients was 41.49 ± 10.962 years. Mean in-hospital stay (p<0.05), pain score at 6 months (p=0.012), grade of SSI (p=0.01), and rate of SSI at 1 week (0.003) differed significantly among the groups. Two cases of recurrence within 6 months of follow-up were reported in IPOM whereas none in eTEP group, however, this difference was not significant (p=0.235). Rest of the outcome variables was comparable between the groups.
Conclusion: The findings of this study indicate that enhanced view extraperitoneal retromuscular sublay repair for ventral hernia correlates with reduced hospital stay, decreased likelihood of chronic pain, and lower incidence of post-operative surgical site infections.
Study design: randomized controlled trial
Study place and duration: Department of Surgical Unit-I, Chaudhry Muhammad Akram Teaching & Research Hospital , Azra Naheed Medical College , Lahore (From Nov 2023 to Oct 2024)
Patients and Methods: 49 ventral hernia patients were randomised into IPOM and eTEP repair groups of 24 and 25. Patients were monitored for discomfort, wound infection, hospital stay, and hernia recurrence after surgery. All data was recorded and analysed with SPSS 26.
Results: Mean age of the patients was 41.49 ± 10.962 years. Mean in-hospital stay (p<0.05), pain score at 6 months (p=0.012), grade of SSI (p=0.01), and rate of SSI at 1 week (0.003) differed significantly among the groups. Two cases of recurrence within 6 months of follow-up were reported in IPOM whereas none in eTEP group, however, this difference was not significant (p=0.235). Rest of the outcome variables was comparable between the groups.
Conclusion: The findings of this study indicate that enhanced view extraperitoneal retromuscular sublay repair for ventral hernia correlates with reduced hospital stay, decreased likelihood of chronic pain, and lower incidence of post-operative surgical site infections.
References
1. Latifi R, Haider A. Abdominal Wall Reconstruction in the Elderly: Techniques, Outcomes, and Pitfalls. Surgical Decision Making in Geriatrics: A Comprehensive Multidisciplinary Approach. 2020:219-28.
2. Smith JaP, J.D. (2020).Ventral Hernia. [online] PubMed. Available at: https://www.ncbi.nlm.nih.gov/books/NBK499927/ [Accessed 25 Feb. 2020].
3. Amato G. Inguinal Hernia: Pathophysiology and Genesis of the Disease: Springer; 2022.
4. Jelinek LA, Jones MW. Surgical access incisions. StatPearls [Internet]: StatPearls Publishing; 2023.
5. Techagumpuch A, Udomsawaengsup S. Update in parastomal hernia. Annals of Laparoscopic and Endoscopic Surgery. 2019;4.
6. Gossage JA, Burnand KM. The abdomen. Browse's Introduction to the Symptoms & Signs of Surgical Disease: CRC Press; 2021. p. 491-547.
7. Ciscar A, Badia JM, Novell F, Bolívar S, Mans E. Incidence and risk factors for trocar-site incisional hernia detected by clinical and ultrasound examination: a prospective observational study. BMC surgery. 2020;20:1-7.
8. Baucom RB, Beck WC, Phillips SE, Holzman MD, Sharp KW, Nealon WH, et al. Comparative evaluation of dynamic abdominal sonography for hernia and computed tomography for characterization of incisional hernia. JAMA surgery. 2014;149(6):591-6.
9. Yu H-X, Han C-S, Xue J-R, Han Z-F, Xin H. Esophageal hiatal hernia: risk, diagnosis and management. Expert review of gastroenterology & hepatology. 2018;12(4):319-29.
10. Jaykar R, Varudkar A, Akamanchi AK. A clinical study of ventral hernia. International Surgery Journal. 2017;4(7):2326-9.
11. Jasti R, Mohan K. Study of Hernias of Anterior Abdominal Wall of Andrapradesh. Indian Journal of Public Health Research & Development. 2019;10(8).
12. Hanif S, Hanif S, Nawaz M. Anterior abdominal wall hernias in regards to prevalence and risk factors. Pakistan Journal of Surgery. 2022;38(1).
13. AhmedAlenazi A, Alsharif MM, Hussain MA, Alenezi NG, Alenazi AA, Almadani SA, et al. Prevalence, risk factors and character of abdominal hernia in Arar City, Northern Saudi Arabia in 2017. Electronic physician. 2017;9(7):4806.
14. de Oliveira FMM, Cavazzola LT, Weltz AS, Belyansky I. Ventral abdominal hernia repair: MIS extraperitoneal repair techniques: eTEP Rives, MILOS/EMILOS, and onlay MIS repair. The SAGES manual of hernia Surgery. 2019:271-90.
15. Bellido Luque J, Gomez Rosado J, Bellido Luque A, Gomez Menchero J, Suarez Grau J, Sanchez Matamoros I, et al. Endoscopic retromuscular technique (eTEP) vs conventional laparoscopic ventral or incisional hernia repair with defect closure (IPOM+) for midline hernias. A case–control study. Hernia. 2021:1-10.
16. Berrevoet F, D'Hont F, Rogiers X, Troisi R, de Hemptinne B. Open intraperitoneal versus retromuscular mesh repair for umbilical hernias less than 3cm diameter. The American journal of surgery. 2011;201(1):85-90.
17. javed moeen Doctors A. COMPARISON BETWEEN OUTCOMES OF IPOM AND SUBLAY MESH HERNIOPLASTY FOR VENTRAL HERNIA. Pakistan Postgraduate Medical Journal. 2018;29(4):134-7.
18. Demetrashvili Z, Pipia I, Loladze D, Metreveli T, Ekaladze E, Kenchadze G, et al. Open retromuscular mesh repair versus onlay technique of incisional hernia: a randomized controlled trial. International Journal of Surgery. 2017;37:65-70.
19. Wieland L, Alfarawan F, Bockhorn M, El-Sourani N. Comparison of eTEP and IPOM for ventral hernia surgery in the early postoperative period: a retrospective cohort study of a tertiary university centre. Hernia. 2024;28(6):2195-206.
20. Li J, Wang Y, Wu L. The Comparison of eTEP and IPOM in Ventral and Incisional Hernia Repair: A Systematic Review and Meta-analysis. Surgical laparoscopy, endoscopy & percutaneous techniques. 2022;32(2):252-8.
2. Smith JaP, J.D. (2020).Ventral Hernia. [online] PubMed. Available at: https://www.ncbi.nlm.nih.gov/books/NBK499927/ [Accessed 25 Feb. 2020].
3. Amato G. Inguinal Hernia: Pathophysiology and Genesis of the Disease: Springer; 2022.
4. Jelinek LA, Jones MW. Surgical access incisions. StatPearls [Internet]: StatPearls Publishing; 2023.
5. Techagumpuch A, Udomsawaengsup S. Update in parastomal hernia. Annals of Laparoscopic and Endoscopic Surgery. 2019;4.
6. Gossage JA, Burnand KM. The abdomen. Browse's Introduction to the Symptoms & Signs of Surgical Disease: CRC Press; 2021. p. 491-547.
7. Ciscar A, Badia JM, Novell F, Bolívar S, Mans E. Incidence and risk factors for trocar-site incisional hernia detected by clinical and ultrasound examination: a prospective observational study. BMC surgery. 2020;20:1-7.
8. Baucom RB, Beck WC, Phillips SE, Holzman MD, Sharp KW, Nealon WH, et al. Comparative evaluation of dynamic abdominal sonography for hernia and computed tomography for characterization of incisional hernia. JAMA surgery. 2014;149(6):591-6.
9. Yu H-X, Han C-S, Xue J-R, Han Z-F, Xin H. Esophageal hiatal hernia: risk, diagnosis and management. Expert review of gastroenterology & hepatology. 2018;12(4):319-29.
10. Jaykar R, Varudkar A, Akamanchi AK. A clinical study of ventral hernia. International Surgery Journal. 2017;4(7):2326-9.
11. Jasti R, Mohan K. Study of Hernias of Anterior Abdominal Wall of Andrapradesh. Indian Journal of Public Health Research & Development. 2019;10(8).
12. Hanif S, Hanif S, Nawaz M. Anterior abdominal wall hernias in regards to prevalence and risk factors. Pakistan Journal of Surgery. 2022;38(1).
13. AhmedAlenazi A, Alsharif MM, Hussain MA, Alenezi NG, Alenazi AA, Almadani SA, et al. Prevalence, risk factors and character of abdominal hernia in Arar City, Northern Saudi Arabia in 2017. Electronic physician. 2017;9(7):4806.
14. de Oliveira FMM, Cavazzola LT, Weltz AS, Belyansky I. Ventral abdominal hernia repair: MIS extraperitoneal repair techniques: eTEP Rives, MILOS/EMILOS, and onlay MIS repair. The SAGES manual of hernia Surgery. 2019:271-90.
15. Bellido Luque J, Gomez Rosado J, Bellido Luque A, Gomez Menchero J, Suarez Grau J, Sanchez Matamoros I, et al. Endoscopic retromuscular technique (eTEP) vs conventional laparoscopic ventral or incisional hernia repair with defect closure (IPOM+) for midline hernias. A case–control study. Hernia. 2021:1-10.
16. Berrevoet F, D'Hont F, Rogiers X, Troisi R, de Hemptinne B. Open intraperitoneal versus retromuscular mesh repair for umbilical hernias less than 3cm diameter. The American journal of surgery. 2011;201(1):85-90.
17. javed moeen Doctors A. COMPARISON BETWEEN OUTCOMES OF IPOM AND SUBLAY MESH HERNIOPLASTY FOR VENTRAL HERNIA. Pakistan Postgraduate Medical Journal. 2018;29(4):134-7.
18. Demetrashvili Z, Pipia I, Loladze D, Metreveli T, Ekaladze E, Kenchadze G, et al. Open retromuscular mesh repair versus onlay technique of incisional hernia: a randomized controlled trial. International Journal of Surgery. 2017;37:65-70.
19. Wieland L, Alfarawan F, Bockhorn M, El-Sourani N. Comparison of eTEP and IPOM for ventral hernia surgery in the early postoperative period: a retrospective cohort study of a tertiary university centre. Hernia. 2024;28(6):2195-206.
20. Li J, Wang Y, Wu L. The Comparison of eTEP and IPOM in Ventral and Incisional Hernia Repair: A Systematic Review and Meta-analysis. Surgical laparoscopy, endoscopy & percutaneous techniques. 2022;32(2):252-8.
Article Sidebar
Published
Nov 21, 2024
Article Details
How to Cite
Muhammad Ammar Fayyaz, Ch Muhammad Aqeel, Pir Muneeb Rehman, Faryal Ufaq, Hafiz Zia Farooq, Hanzla Khalid, & Mohammed Aslam7. (2024). COMPARISON BETWEEN ENHANCED VIEW TOTAL EXTRA-PERITONEAL RETRO-MUSCULAR (ETEP) APPROACH VERSUS INTRAPERITONEAL ONLAY MESH (IPOM) FOR VENTRAL HERNIA REPAIR. Journal of Population Therapeutics and Clinical Pharmacology, 31(11), 1570-1577. https://doi.org/10.53555/h280xx53
Section
Articles
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Author Biographies
Muhammad Ammar Fayyaz
THQ hospital Safdar Abad district Sheikhupura, Pakistan
Ch Muhammad Aqeel
Assistant Professor of Surgery, Azra Naheed Medical College, Lahore, Pakistan
Pir Muneeb Rehman
Assistant Professor Surgery, Services Institute of Medical Sciences Lahore, Pakistan
Faryal Ufaq
Senior Registrar Surgery CMA Teaching Hospital Lahore, Pakistan.
Hafiz Zia Farooq
Senior Registrar Surgery, CMA Teaching Hospital Lahore, Pakistan.
Hanzla Khalid
Khalid Clinic Village Maingri Ansarian P.O Noorkot Tehsil Shakargarh District Narowal, Pakistan
Mohammed Aslam7
Professor of Surgery Azra Naheed Medical college Lahore, Pakistan.
How to Cite
Muhammad Ammar Fayyaz, Ch Muhammad Aqeel, Pir Muneeb Rehman, Faryal Ufaq, Hafiz Zia Farooq, Hanzla Khalid, & Mohammed Aslam7. (2024). COMPARISON BETWEEN ENHANCED VIEW TOTAL EXTRA-PERITONEAL RETRO-MUSCULAR (ETEP) APPROACH VERSUS INTRAPERITONEAL ONLAY MESH (IPOM) FOR VENTRAL HERNIA REPAIR. Journal of Population Therapeutics and Clinical Pharmacology, 31(11), 1570-1577. https://doi.org/10.53555/h280xx53