Comparison of Trans Abdominal Pre-peritoneal (TAPP) and Enhanced view Totally Extraperitoneal Rives Stoppa (e-TEP RS) repair for Primary Umbilical and Para umbilical Hernia – a Randomized Controlled Study

Ventral hernia of anterior abdominal wall is a common surgical problem due to any musculo-aponeurotic defect of anterolateral parietal abdominal wall through which protrusion of intra-abdominal or preperitoneal contents occurs. Midline primary hernias include epigastric, umbilical and paraumbilical hernias. Umbilical hernias occur due to conditions that cause stretching and thinning of the midline raphe (linea alba), such as in pregnancy, obesity, ascites and predisposes to reopening of umbilical defect. Paraumbilical hernias occur when a defect in linea alba is adjacent to the true umbilicus. In the current era, so many different options for the management of these hernias are available from various open to minimal invasive techniques, and these diversity of techniques makes the decision making more difficult in ventral hernias. The major advantage of laparoscopic hernia repair was the cosmetic benefit, early ambulation, less operative complications, less hospital stay, less blood loss and less chances of recurrence. The disadvantages of laparoscopic surgery included technical difficulty, use of general anesthesia and equipment cost. Minimal invasive procedures with different techniques and mesh positions have evolved rapidly in the last decade.The e-TEP technique is based on the principle that the extra peritoneal space can be created from almost anywhere in the anterior abdominal wall. Trans Abdominal Pre-Peritoneal technique involves the dissection of peritoneum off the posterior rectus sheath, with a mesh placed in the preperitoneal space. Both eTEP and TAPP are described in literature, but there is no direct comparison among the two techniques. Thus, this study will attempt to compare the short-term outcomes between eTEP and TAPP approaches to primary umbilical hernias and attempt to better define the indications for the two procedures.