Endoscopic totally extraperitoneal (eTEP) versus intraperitoneal onlay mesh (IPOM) repair for ventral hernias: a systematic review and meta-analysis

Objective. To compare safety and efficacy of eTEP and IPOM in endoscopic treatment of ventral hernias. Material and methods. A systematic review and meta-analysis of RCTs for 2019—2025 in PubMed, EMBASE, Cochrane Library, Web of Science, eLibrary.Ru was performed. Fixed-effect (dichotomous outcomes) and random-effect (continuous outcomes) models were used. Results. Twelve RCTs (694 patients: 348 eTEP, 346 IPOM) were included. Surgery time was shorter in IPOM (89.8±28.5 vs. 134.9±39.4 min; p<0.001). The risk of bowel injury was 7.73 times higher [1.73; 34.61], and risk of postoperative intestinal obstruction was 3.67 times higher in IPOM [1.95; 6.91]. Pain after 24 hours and 7 days was higher in the same group (VAS score difference 2.21 [2.07; 2.36] and 1.27 [0.86; 1.67], respectively). Recurrence rates and hospital-stay did not differ. Conclusion. Extraperitoneal repair (with low GRADE certainty) is associated with less postoperative pain and lower odds of bowel injury than IPOM. However, eTEP has specific complications (separation of posterior rectus sheath and linea alba with severe consequences), longer surgery time, technical complexity, and need for conversion. Our conclusions are not definitive due to low quality of evidence. Large multiple-center RCTs are needed. The choice of method should be based on surgical experience and patient characteristics.