To evaluate the efficacy of laparoscopic enhanced-view totally extraperitoneal repair (e-TEP) versus intraperitoneal onlay mesh repair (IPOM) in the treatment of adult umbilical hernia.

This study was a retrospective cohort study. The clinical data of 19 umbilical hernia patients in Lu'an People's Hospital from January 2020 to December 2023 were retrospectively analyzed. These patients were divided into an e-TEP group (undergoing laparoscopic enhanced view totally extra peritoneal repair, n=10) and an IPOM group (receiving laparoscopic intraperitoneal onlay mesh repair, n=9). The operation time, length of hospital stay, hospitalization expenses, postoperative pain within 6 months, and incidence of complications within 12 months postoperatively were observed and compared between the two groups.

Compared with the IPOM group, the e-TEP group had a longer mean operative time [(125.50±8.96) minutes vs. (74.44±9.17) minutes], a shorter mean postoperative hospital stay [(3.90±0.74) days vs. (6.89±0.78) days], and a lower mean hospitalization cost [(10 315.09±676.64) yuan vs. (27 581.12±1432.92) yuan], with all differences being statistically significant (P<0.001). Two-way repeated- measures ANOVA showed that compared with the IPOM group, the e-TEP group had lower pain scores (VAS) at all postoperative time points, and the difference in overall pain scores between the two groups was statistically significant (F_group=104.31, P_group<0.001). The pain scores in both groups decreased with the prolongation of postoperative time (F_time=120.50, P_time<0.001), and there was a significant interaction between operation method and time (F_interaction=68.22, P_interaction<0.001). Post hoc multiple comparisons between groups at the same time points were conducted using the Bonferroni method. At each postoperative time point (1, 3, 7, 15 days, and 1, 3, 6 months), the pain score in the eTEP group was significantly lower than that in the IPOM group (P<0.001). During the 12-month follow-up period, no patients were lost to follow-up. There were no cases of hernia recurrence, incision infection, or seroma in either group. One patient in the IPOM group developed constipation and intestinal obstruction postoperatively. Postoperative adhesive intestinal obstruction was considered highly likely, and the symptoms were relieved by dietary modification.

Laparoscopic e-TEP is associated with less postoperative pain and faster recovery but requires a longer operative time. In contrast, IPOM is technically less demanding but is associated with more pronounced postoperative pain and higher overall costs. The choice of surgical approach should be based on the surgeon's proficiency and the patient’s economic status.