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. 2025 Mar;39(3):2099-2107.
doi: 10.1007/s00464-025-11565-z. Epub 2025 Feb 3.

A retrospective cohort study of laparoscopic enhanced view totally extra-peritoneal Rives-Stoppa (eTEP-RS) repair of incisional ventral hernias in patients with morbid obesity

Shlomi Rayman  1 , Mohamad Molham  2 , Ran Orgad  2 , Hana Gelman  3 , Eliyahu Gorgov  2 , Youri Mnouskin  2
Affiliations

A retrospective cohort study of laparoscopic enhanced view totally extra-peritoneal Rives-Stoppa (eTEP-RS) repair of incisional ventral hernias in patients with morbid obesity

Shlomi Rayman et al. Surg Endosc. 2025 Mar.

Abstract

Background: Incisional hernia (IH) repair in morbidly obese (MO) patients poses significant challenges due to higher risks of complications and recurrence. Traditional open repairs are linked to increased morbidity, driving interest in minimally invasive techniques. The enhanced view totally extra-peritoneal Rives-Stoppa (eTEP-RS) technique shows promise as a laparoscopic method for IH repair, but data on its efficacy and safety in MO patients are limited. This study aims to evaluate the efficacy, safety, and feasibility of the eTEP-RS approach specifically for IH repair in this high-risk population.

Methods: Analysis of a retrospective cohort of consecutive patients undergoing laparoscopic eTEP-RS for IH repair between 2017 and 2022 which included 135 patients, categorized into two groups based on body mass index (BMI): the MO group (BMI > 35 kg/m2) and the control group (BMI ≤ 35 kg/m2). We compared demographics, comorbidities, hernia characteristics, intra-operative data, post-operative outcomes, and hernia recurrence rates.

Results: Patients in the MO group had significantly more type 2 diabetes mellitus (n = 18, 51% vs n = 25, 25%; p = 0.004), hypertension (n = 35, 73% vs n = 75, 53%; p = 0.017), dyslipidemia (n = 29, 60% vs n = 58, 41%; p = 0.021), ASA score 3 (n = 18, 52% vs n = 23, 23%; p = 0.004), a history of previous umbilical hernia repair (n = 13, 27% vs n = 13, 9.2%; p = 0.002), and bariatric surgery (n = 10, 29% vs n = 13, 13%; p = 0.035). There were no differences in intra-operative characteristics, operative times, or intra-operative complications between groups. During a median follow-up period of 1 year (IQR 40-680 days), there were no differences in hernia recurrence (n = 2, 5.7% vs n = 9, 9%; p = 0.07), time to recurrence, or chronic analgesia usage between groups.

Conclusion: The laparoscopic eTEP-RS approach was safe and effective for IH repair in patients with MO, demonstrating comparable post-operative outcomes and recurrence rates to those with a lower BMI in a selected cohort of patients.

Keywords: Enhanced-view totally extra-peritoneal hernia repair; Incisional hernia; Laparoscopic ventral hernia repair; Morbid obesity; Rives-Stoppa; eTEP.

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Conflict of interest statement

Declarations. Disclosures: Shlomi Rayman, Mohamad Molham, Ran Orgad, Hana Gelman, Eliyahu Gorgov, and Youri Mnouskin have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
Scatter plot representing the correlation between hernia size and body mass index
See this image and copyright information in PMC

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