LAUSR

The Rives-Stoppa (RS) procedure is a gold standard in the treatment of midline abdominal wall hernias. Comparability of pain control and outcomes to the less invasive enhanced-view totally extraperitoneal prosthetic (eTEP) repair remain unclear. Single centre surgical cohort including 30 RS repairs (January 2019 – November 2021), and 30 consecutive eTEP procedures (September 2021 – August 2022) for midline abdominal wall hernia(s) with rectus abdominis diastasis. Postoperative pain and outcomes were compared. Presence and median duration of patient-controlled analgesia (PCA) were respectively 90% and 3 nights with RS, versus 30% and 0 nights with eTEP. Median switch to only oral analgesics occurred at postoperative day (POD) 3 after RS and at POD 2 after eTEP. Postoperative analgesics and opioid prescription at discharge were comparable between groups. Median length of hospital stay was 6 nights after RS versus 3 nights after eTEP. Median duration of surgery was 110.5 and 164.5 minutes for RS and eTEP respectively. After RS, 30 patients had a postoperative drain compared to 3 patients after eTEP. Conversion was needed in 3 eTEP procedures. Postoperative complications were comparable. No early recurrences were observed. Minimal residual diastasis was observed at postoperative consultation in 11 patients after eTEP. eTEP is a feasible minimally invasive alternative to RS for the treatment of midline abdominal wall hernias with rectus abdominis diastasis and is associated with a shorter length of hospital stay, less postoperative pain and a comparable risk of short-term complications. Registration number: NCT05446675 (ClinicalTrials.gov).