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Abstract：
Background Primary ventral hernias are abnormal protrusions of abdominal viscera through the areas of weakness in the fascia of the abdominal wall. The aim of this study was to compare the benefits and complications, and the overall outcome in the Extended-View Totally Extraperitoneal Rives-Stoppa (eTEP-RS) repair versus Intraperitoneal Onlay Mesh (IPOM Plus) repair in the management of primary ventral hernias. Methods After obtaining institutional ethical committee clearance, this prospective comparative study between IPOM Plus and eTEP-RS was conducted in a tertiary care hospital from December 2020 to January 2022. A total of 50 patients presenting with primary ventral hernias were included in the study, of whom 25 underwent IPOM Plus and 25 underwent eTEP-RS repairs. Group selection was done by simple randomization using the lottery method. Patients more than 18 years of age with primary ventral hernias presenting with a hernial defect width less than 6 cm, consenting to the study, were included in the study. Patients who did not fulfill the inclusion criteria, strangulated/obstructed hernias, recurrent/incisional hernias, connective tissue disorders, skin infections, enterocutaneous fistulas, pregnancy, morbid obesity, and parastomal hernias were exclusion factors. Results The mean intraoperative duration in the eTEP-RS group (192.3 ± 16.20 min) was significantly higher than in the IPOM Plus group (102.6 ± 16.78min, p=0.001). The mean duration of hospital stay in the IPOM Plus group (5.9 ± 2.19 days) was longer than in the eTEP-RS group (4.6 ± 3.17 days, p=0.02). The mean postoperative pain scores, from the Visual Analogue Scale (VAS), on days 1, 7, and 90 were 3.2 ± 1.11, 2.64 ± 1.11, and 1.68 ± 1.46 in the IPOM Plus group and 1.84 ± 0.688, 0.76 ± 0.66 and 0.08 ± 0.40 in the eTEP-RS group, respectively (p=0.001). Conclusion Despite being a technically easy procedure requiring less intraoperative time, IPOM Plus had several disadvantages, such as increased postoperative pain, longer duration of hospital stays, higher chances of wound site seromas, and higher rates of postoperative paralytic ileus. On the other hand, eTEP-RS was a more challenging procedure requiring more intraoperative time; however, it had several advantages: less postoperative pain, less duration of hospital stay, early recovery, and fewer chances of seromas and paralytic ileus. However, more robust data is required to compare and validate the differences between both procedures\' short- and long-term outcomes.
摘要：
背景原发性腹侧疝是腹部内脏通过腹壁筋膜薄弱区域的异常突起。这项研究的目的是比较的好处和并发症，以及在原发性腹侧疝的治疗中，扩展视图完全腹膜外Rives-Stoppa（eTEP-RS）修复与腹膜内嵌网（IPOMPlus）修复的总体结果。方法在获得机构伦理委员会许可后，这项IPOMPlus和eTEP-RS的前瞻性比较研究于2020年12月至2022年1月在一家三级医院进行.共有50例原发性腹侧疝患者被纳入研究，其中25人接受了IPOMPlus，25人接受了eTEP-RS维修。小组选择是通过使用抽奖方法的简单随机化来完成的。年龄超过18岁的原发性腹侧疝患者，其疝缺损宽度小于6cm，同意这项研究，包括在研究中。不符合纳入标准的患者，绞窄/阻塞疝，复发性/切口疝,结缔组织疾病,皮肤感染,肠皮肤瘘,怀孕,病态肥胖,造口旁疝是排除因素。结果eTEP-RS组的平均术中持续时间（192.3±16.20min）明显高于IPOMPlus组（102.6±16.78min，p=0.001)。IPOMPlus组的平均住院时间（5.9±2.19天）长于eTEP-RS组（4.6±3.17天，p=0.02)。术后平均疼痛评分,从视觉模拟量表（VAS），在第1、7和90天，IPOMPlus组为3.2±1.11、2.64±1.11和1.68±1.46，eTEP-RS组为1.84±0.688、0.76±0.66和0.08±0.40，分别(p=0.001)。结论尽管是一种技术简单的手术，需要较少的术中时间，IPOMPlus有几个缺点，如术后疼痛增加，住院时间较长，伤口部位血清肿的机会更高，术后麻痹性肠梗阻的发生率较高。另一方面,eTEP-RS是一种更具挑战性的手术，需要更多的术中时间；然而，它有几个优点:术后疼痛少，住院时间较短，早期恢复,减少血清和麻痹性肠梗阻的机会。然而,需要更可靠的数据来比较和验证这两个程序的短期和长期结果之间的差异。
