Minimally invasive endoscopic retromuscular technique with transversus abdominis release associated (eTEP-TAR) for right subcostal incisional hernias improves postoperative results when compared to conventional laparoscopic incisional hernia repair: a case-control study.

Methods: The aim was to evaluate results in terms of intra and postoperative complications, hospital stay, postoperative pain, functional recovery, aesthetic results and recurrence rate of totally endoscopic retromuscular hernia repair(eTEP-TAR)compared to conventional laparoscopic incisional hernia repair with defect closure(IPOM+)for right subcostal incisional hernias. Methods: Data from consecutive patients requiring conventional minimally invasive subcostal incisional hernia repair collected from January 2014 to December 2018 were compared with patients underwent eTEP from January 2019 to July 2024 in a case-control study.

Results: 51 patients in the IPOM + group and 46 in eTEP group were included.Both groups were comparable considering demographic variables.No significant differences were identified in mean defect length (6,6+/-1,4 vs. 7,5+/-1,2 cm, p = 0,08) or width(6,3+/-1,5 vs. 5,9+/-1,4 cm, p = 0,3).The mean mesh area was significantly bigger in eTEP group(907,9+/-136,4 vs. 631,5+/-129,3 cm2,p < 0,05)with significant longer surgical time (106,3+/-22,7 vs. 67,2+/-15,5 min, p = 0,03).No differences in intraoperative complications were identified.Hospital stay was significantly improved in eTEP group when compared to IPOM + group (33,6+/-13,8 vs. 61,09+/-12,2 hours, p = 0,03).Postoperative complications were significantly higher in the IPOM + group due to postoperative ileus (9% vs. 2%,p < 0,05).One recurrence was identified in eTEP group(2%), and 2 recurrences in IPOM + group(3%) with an average follow-up of 20.6+/-10.6 months and 60.6+/-10.6 months respectively. eTEP group showed significantly lower pain on the 1st -7th -30th -90th postoperative days than IPOM + group.Functional recovery was significantly improved in the eTEP group one and six months after surgery.No differences in terms of cosmetic results were identified.

Conclusions: eTEP-TAR for subcostal hernias shows lower postoperative pain and hospital stay with better functional recovery than IPOM+,without differences in recurrence rate and cosmesis result.Postoperative ileus is increased when intraperitoneal mesh is laparoscopically placed. eTEP-TAR in subcostal hernia repair requires significant higher operative time due to its complexity.