Transabdominal retro muscular versus intraperitoneal onlay mesh repair of ventral hernia: a randomized controlled study

Abstract

Background Although laparoscopic ventral hernia repair has become a well-established alternative for open repair, traditional intraperitoneal mesh placement in direct contact with the bowel had many drawbacks and complications; in addition, it requires extensive mesh fixation and special composite mesh. Using the peritoneum and posterior rectus sheath as a barrier between the mesh and the bowel will evade these complications and decrease the cost. Patients and methods This prospective study was conducted in between May 2022 and December 2022 on 50 patients with noncomplicated ventral hernia with an average defect size of 5 cm. Patients were randomly allocated into two groups: intraperitoneal onlay mesh (IPOM) group (25) patients and transabdominal retro muscular mesh (TARM) group (25) patients. Both groups were compared as regards preoperative demographics, intraoperative complications and operative time and postoperative outcomes and complications. Results With a mean age of (44.96±7.27) of IPOM and (48.92±7.17) of TARM group, a significant longer operative time was spent in TARM repair (108.40±9.43 min). Postoperative pain was less in patients with TARM repair and hence they had earlier recovery and restoration of daily activities. Using a double-face composite mesh made the cost of IPOM repair significantly higher than TARM (P < 0.001). Overall postoperative complications and recurrence rate showed no significant difference between both techniques. Conclusion TARM repair seems to be a safe and good alternative to IPOM repair in terms of lower economic cost and less postoperative pain.