To evaluate the impact of laparoscopic preperitoneal mesh repair (LPPMR) on early postoperative pain and quality of life in adult patients undergoing umbilical hernia repair.

This is a retrospective cohort study. A retrospective analysis of the medical records of patients who underwent umbilical hernia repair at the First Affiliated Hospital of Xi 'an Jiaotong University between June 2023 and June 2025 was conducted. Patients were categorized into two groups based on surgical approach preference at admission and surgeon expertise: the LPPMR group (n=48), receiving laparoscopic preperitoneal mesh repair, and the IPOM group (n=48), receiving laparoscopic intraperitoneal onlay mesh repair. Comparative analyses were performed between the two groups on operative parameters, early postoperative pain levels, recovery of abdominal wall muscle function, postoperative quality of life, and follow-up outcomes.

Operative duration was significantly longer in the LPPMR group compared to the IPOM group. However, the LPPMR group demonstrated significantly shorter time to first flatus and lower overall surgical costs (P<0.05). Visual analog scale (VAS) pain scores assessed at 24, 48, 72 h, and 1 week postoperatively were lower in the LPPMR group than those in the IPOM group. Repeated- measures analysis of variance (ANOVA) indicated significant main effects for both time (F=334.600, P<0.001) and surgical group (F=16.932, P<0.001) on early postoperative pain, with no significant interaction (P>0.05). At 1 and 3 months after surgery, the LPPMR group exhibited superior performance in plank hold times, supine static crunch times, and number of bridge exercises than those in the IPOM group. The repeated measures ANOVA showed that the effects of time and group were significant for all the above three indicators (all P values<0.001), while the interaction effects were not significant (all P values>0.05). Furthermore, quality of life assessments at 1, 3, and 6 months after the surgery revealed significantly higher scores in both the physical and psychological domains for the LPPMR group than those of the IPOM group. Repeated-measures ANOVA showed significant time effects across all domains (P<0.001), with group effects significant only for the physical (F=17.948, P<0.001) and psychological (F=25.134, P<0.001) domains. The interaction effect had no significant effect on any of these four domains (all P>0.05). No hernia recurrences were reported in either group during follow-up. One month after the operation, the incidence of incision site pain (6.25% vs 20.83%) and foreign body sensation (4.17% vs 16.67%) was significantly lower in the LPPMR group than that in the IPOM group (P<0.05). The overall complication rates did not differ significantly between the two groups (P>0.05).

Both LPPMR and IPOM are safe and effective procedures for umbilical hernia repair. Although associated with a longer operative time, LPPMR offers distinct advantages, including reduced early postoperative pain, enhanced recovery of abdominal wall function, and improved short-term quality of life. LPPMR may serve as a preferred option for patients prioritizing rapid recovery and quality of life, though surgeon learning curve and operative time should be considered.