Randomised control trial comparing pain, quality of life and cost between laparoscopic ventral transabdominal preperitoneal (vTAPP) plus vs. intraperitoneal onlay mesh (IPOM) plus repair for primary ventral hernia

Primary ventral hernia repair is a common surgical procedure, but the optimal technique for achieving the best outcomes remains a topic of ongoing debate. The standard technique, Intraperitoneal Onlay Mesh (IPOM) plus, has been widely used and studied. Although it is technically easy to perform, presence of an intraperitoneal mesh and use of tackers has potential to cause life threatening complications such as severe post-operative pain, adhesive intestinal obstruction, fistulas and abscess. Besides this, as the mesh is placed intra-peritoneally, a composite (dual layered) mesh is needed and tacking devices to fix the mesh. This leads to increased costs when compared to use of a single layered polypropylene mesh without need for tackers. These reasons eventually impact on the patients’ quality of life in the long term. Due to these reasons, attempts have been made to develop other techniques which allow placement of mesh outside the peritoneal cavity and remove the need to use fixation devices. Some surgeons are employing techniques, which place mesh in the retrorectus space, however, they need extensive dissection and division of the natural structures such as the posterior rectus sheath, which may have potential to cause hernia recurrence on the long run. Hence, attempts have been made to place the mesh in the pre- peritoneal space trans-abdominally. This technique of ventral transabdominal pre-peritoneal repair (vTAPP) is derived from the transabdominal preperitoneal repair (TAPP) used for inguinal hernia repairs routinely. The technique prevents use of intraabdominal mesh, avoids the need for fixation devices such as tackers and avoids the use of a composite mesh. Thereby, reducing product cost and avoiding the potential complications, especially severe pain, adhesions and fistula formation. However, these techniques are technically difficult to perform. Some retrospective studies are available in literature with conflicting results. Hence, we designed this randomized controlled trial comparing Laparoscopic vTAPP Plus versus the standard IPOM Plus for Ventral Hernia Repair in terms of outcomes, quality of life and cost effectiveness.