Enhanced view/extended totally extraperitoneal plasty (eTEP) Rives–Stoppa repair versus open Rives–Stoppa repair: a single-center retrospective propensity score-matched cohort study

BACKGROUND: To evaluate the comparative effectiveness of extended totally extraperitoneal plasty Rives-Stoppa retromuscular repair (eTEP-RS) and open Rives-Stoppa retromuscular repair (Open-RS) in patients undergoing ventral hernia repair. METHODS: Clinical data from 850 patients were collected in a prospectively maintained database and retrospectively evaluated. 153 patients undergoing eTEP-RS were compared to 154 selected patients undergoing Open-RS (from the period prior to implementation of eTEP-RS at our university medical center). Short-term perioperative outcomes as well as long-term recurrence rate and quality of life by Carolina Comfort Scale (QoL) were evaluated. Results are shown as median (interquartile range). RESULTS: Our learning curve phase (first 60 eTEP-RS cases) was compared to eTEP-RS from the steady-state phase (cases 61-153). Significant differences with regard to operation time and perioperative complications were observed indicating a relevant learning curve in the procedure. The eTEP-RS cases from the steady-state cohort were compared to the Open-RS cases. After propensity score matching, 83 eTEP-RS cases were compared to 83 Open-RS cases. While operation time was longer (Open-RS: 135 min (95-161); eTEP-RS: 160 min (126-192); i = 0.004), length of stay was shorter in the eTEP-RS cohort (Open-RS: 7 days (6-9); eTEP-RS: 4 days (3-5); p < 0.001) and postoperative pain was lower on postoperative days 2 and 3. Perioperative complications, hernia recurrence rates, and long-term QoL were not different between the two cohorts. CONCLUSION: eTEP Rives-Stoppa repair offered superior short-term outcomes compared to open Rives-Stoppa repair in suitable patients with medium-sized ventral hernia and selected patients with large ventral hernia. Given the short follow-up period, no statistically significant differences could be observed regarding the long-term outcomes recurrence rate and QoL. Future long-term multicenter studies are necessary to evaluate long-term efficacy.