Beyond Traditional Repair: Comparing eTEP and Open Sublay for Ventral Hernia Repair

<b>Background:</b> Ventral hernias are common abdominal wall defects requiring surgical repair to prevent complications. This study compared two techniques: minimally invasive enhanced-view totally extraperitoneal (eTEP) approach and the open sublay (OS) method, historically regarded as the gold standard. <b>Methods:</b> A retrospective single-center study was conducted between July 2019 and March 2023 at the Department for General and Visceral Surgery, Klinikum Oldenburg. All patients who underwent either eTEP or OS for ventral hernia repair were included. Patient demographics and perioperative data were collected and compared. <b>Results:</b> A total of 139 patients were analyzed, with 92 undergoing eTEP repair and 47 undergoing OS. Both groups were comparable in demographic and clinical characteristics. Significant differences were found in defect size (median 6 cm² for eTEP vs. 16 cm² for OS, <i>p</i> < 0.028) and mesh size (median 450 cm² for eTEP vs. 150 cm² for OS <i>p</i> < 0.001). Operative time (<i>p</i> = 0.119) and postoperative pain levels over 3 days showed no significant differences (VAS Day1 <i>p</i> = 0.884; VAS Day3 <i>p</i> = 0.636). Intraoperative complications were 2.17% for eTEP and 6.38% for OS (<i>p</i> = 0.207). Postoperative complications (6.52% vs. 21.28%, <i>p</i> = 0.009) and hospital stay (median 3 days vs. 5 days, <i>p</i> < 0.001) were significantly lower in the eTEP group. <b>Conclusions:</b> eTEP is a safe, effective procedure and appears to offer more advantages than OS for ventral hernia repair. It is associated with a significantly lower complication rate, as well as shorter hospital stay.