Endoscopic retromuscular technique (eTEP) vs conventional laparoscopic ventral or incisional hernia repair with defect closure (IPOM +) for midline hernias. A case–control study



This study aimed at clinical results in terms of postoperative pain and functional recovery of new technique (eTEP) compared to IPOM + for ventral/incisional midline hernias. Recurrence rate, intra/postoperative complications and aesthetic results are secondary aims.


Data from consecutive patients requiring minimally invasive hernia repair were collected. From January 2015 to September 2018, patients with midline ventral/incisional hernias underwent IPOM + were compared to patients underwent eTEP procedure from October 2018 to December 2019 in a case/control study.


Thirty-nine patients in IPOM + group and 40 in eTEP group were included. No significant differences were identified when hernias types, mean defect area, mean mesh area and intraoperative/postoperative complications (except seroma rate in favor of eTEP group) were compared. Operative time and hospital stay were significantly higher in eTEP group and IPOM + group, respectively. eTEP group showed significantly less pain on 1st, 7th and 30th postoperative days than IPOM + group. Restriction of activities was significantly decreased in eTEP group on the 30th and 180th day after surgery. Significant differences were observed in terms of cosmetic results 30th and 180th days after surgery in favor of eTEP group.

Average follow-up was 15 months in eTEP group and 28 months in IPOM + group. No recurrences were identified in eTEP group and one recurrence in IPOM + group with no significant differences.


Endoscopic retromuscular technique shows significant lower postoperative pain, better functional recovery and cosmesis than IPOM + without differences in intra/postoperative complications (except seroma rate) or recurrences during the follow-up. eTEP requires longer operative time.

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Data availability

Data are available in IBM SPSS Statistics Base version 25.0 tables and Microsoft excel 16.4.


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This study complies with the current laws of Spain, in which it has been performed.

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Correspondence to J. Bellido Luque.

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Authors Juan Bellido Luque, Juan Carlos Gomez Rosado, Araceli Bellido Luque, Julio Gomez Menchero, Juan Manuel Suarez Grau, Inmaculada Sanchez Matamoros, Angel Nogales Muñoz, Fernando Oliva Mompeán, Salvador Morales Conde declare that they have no conflict of interest. Conflict of interest is recorded in the potential conflict of interest disclosure forms.

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Approval was obtained from the ethics committee of University of Seville (Spain), Virgen de la Macarena Hospital. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Bellido Luque, J., Gomez Rosado, J.C., Bellido Luque, A. et al. Endoscopic retromuscular technique (eTEP) vs conventional laparoscopic ventral or incisional hernia repair with defect closure (IPOM +) for midline hernias. A case–control study. Hernia (2021). https://doi.org/10.1007/s10029-021-02373-0

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  • eTEP
  • Totally endoscopic retromuscular repair
  • Minimally invasive ventral hernias
  • Extraperitoneal ventral hernia