Laparoscopic e-TEP Versus Open Mesh Repair for Umbilical and Para-Umbilical Hernias: A Prospective Comparative Study

Abstract

Background: Umbilical and para-umbilical hernias account for 10–14% of all abdominal wall hernias. While
open mesh repair remains widely practised, the enhanced-view totally extraperitoneal (e-TEP) technique
offers a minimally invasive retromuscular approach that avoids intraperitoneal mesh placement. Robust
prospective comparative data, particularly from India, remain scarce.
Methods: This prospective comparative study included 54 adult patients with primary umbilical or para-
umbilical hernias (defect 2–6 cm) operated at a tertiary care centre. Patients were allocated to
laparoscopic e-TEP repair (Group B, n = 27) or open mesh repair (Group A, n = 27). Primary outcomes
included postoperative pain (Visual Analogue Scale [VAS] at 24 h and 72 h), hospital stay, and time to return
to activity. Secondary outcomes included chronic pain VAS at 6 months and quality of life (EuraHS-QoL) at
6 and 12 months.
Results: Both groups were comparable in age (42.4 ± 14.1 vs 44.5 ± 17.3 years), BMI (27.1 ± 3.2 vs 26.4 ±
2.8 kg/m²), and defect size (2.92 ± 0.83 vs 3.01 ± 0.78 cm). Operative time was significantly longer in the
e-TEP group (136.9 ± 25.9 vs 89.1 ± 16.6 min; p < 0.001). The e-TEP group demonstrated significantly lower
VAS pain scores at 24 h (3.07 ± 0.78 vs 5.59 ± 0.80; p < 0.001) and 72 h (1.89 ± 0.85 vs 4.85 ± 0.82; p <
0.001), shorter hospital stay (3.00 ± 0.92 vs 5.67 ± 1.21 days; p < 0.001), earlier return to activity (10.9 ±
2.3 vs 22.8 ± 5.6 days; p < 0.001), and lower chronic pain VAS at 6 months (1.85 ± 0.82 vs 4.63 ± 1.31; p <
0.001). EuraHS-QoL scores at 6 months (83.4 vs 83.9) and 12 months (88.4 vs 87.2) were comparable. No
recurrence was recorded in either group.
Conclusions: Laparoscopic e-TEP repair is a safe and effective alternative to open mesh repair for umbilical
and para-umbilical hernias, offering significantly superior short-term and medium-term outcomes in terms
of postoperative pain, hospital stay, functional recovery, and chronic pain, without compromising
recurrence rates. The longer operative time reflects the learning curve of the technique.