To evaluate the clinical efficacy of laparoscopic total extraperitoneal patch repair (TEP) in the treatment of adult umbilical hernia.

A retrospective cohort study was conducted including 76 patients with umbilical hernias admitted to Hanzhong People's Hospital between February 2022 and February 2025. Patients were assigned to a control group (n=33) and an observation group (n=43). The control group underwent laparoscopic intraperitoneal onlay mesh (IPOM), whereas the observation group underwent laparoscopic TEP. The surgery-related indicators, visual analog scale (VAS) pain score, gastrointestinal function recovery, stress factor indicators, peripheral blood inflammatory factor indicators, complications and recurrence were compared between the two groups.

The observation group had a significantly longer operative time (8.16, 95% CI 0.74–15.58 min) and intraoperative blood loss (0.84, 95% CI 0.12–1.56 ml) compared to the control group, while showing shorter postoperative first out-of-bed time (-1.37, 95% CI -2.33–-0.41 h) (P<0.05). Repeated-measures analysis of variance (ANOVA) for pain VAS scores showed significant main effects of time, group, and their interaction (F_time=454.7, F_group=15.22, F_interaction=3.079; all P<0.05). The overall pain level in the observation group was significantly lower than that in the control group, and pain relief was more rapid in the observation group. For simple effects analysis at each time point revealed that the observation group had significantly lower pain VAS scores at postoperative day 1 and postoperative week 1 (P<0.05). All parameters including first anal gas expulsion time (-0.81, 95% CI -1.51–-0.11 h), first bowel movement time (-2.73, 95% CI -4.62–-0.84 h), intestinal sound recovery time (-1.12, 95% CI -2.11–-0.13 h), and resumption of feeding time (-1.34, 95% CI -2.30–-0.38 h) were significantly shorter in the observation group (P<0.05). On postoperative day 1, serum levels of epinephrine (-8.08, 95% CI -14.18–-1.98 pg/ml), cortisol (-10.69, 95% CI -21.05–-0.33 nmol/L), and noradrenaline (-7.07, 95% CI -12.61–-1.53 pg/ml) were elevated in both groups compared to preoperative levels, with the observation group showing lower values than the control group (P<0.05). No cases of incomplete intestinal obstruction or hernia recurrence were observed in either group at 3 months postoperatively, and there was no statistically significant difference in overall complication rates (P>0.05).

Compared with IPOM, laparoscopic TEP in the treatment of adult umbilical hernia offers advantages in promoting early ambulation and reducing early postoperative pain, is associated with reduced stress levels, and demonstrates a favorable safety profile.