Comparative Study Between Extended-View Totally Extraperitoneal Rives-Stoppa Repair and Intraperitoneal Onlay Mesh Plus Repair for Ventral Abdominal Wall Hernias: A Randomized Controlled Trial.

Introduction Ventral hernias are among the most common abdominal wall defects encountered in surgical practice and are increasingly managed laparoscopically due to lower postoperative morbidity and faster recovery times. While the intraperitoneal onlay mesh plus (IPOM Plus) technique is widely practiced, the extended totally extraperitoneal Rives-Stoppa (e-TEP RS) approach enables extraperitoneal mesh placement and may offer improved outcomes. This study aims to compare the two techniques regarding operative parameters, complications, and patient-reported outcomes. Methods A prospective randomized controlled trial was conducted at Ganesh Shanker Vidyarthi Mandir (GSVM) Medical College, Kanpur, from February 2024 to April 2025. A total of 174 patients with primary or incisional ventral hernias were randomized into two groups: e-TEP RS (n = 87) and IPOM Plus (n = 87). Outcomes assessed included operative time, pain using Visual Analogue Scale (VAS) scores, hospital stay, return to activity, complications (seroma, hematoma, surgical site infections, and recurrence), chronic pain, quality of life, and conversion rate over six months. This study was registered on ClinicalTrial.gov with the identifier NCT07055464. Results The e-TEP RS group had a significantly longer operative time (170.2 ± 14.0 min vs. 90.7 ± 9.9 min;