Preperitoneal extended totally extraperitoneal (PeTEP) repair for ventral hernia: A systematic review and meta-analysis.

PURPOSE: Ventral hernias are common abdominal wall defects associated with substantial healthcare burden and impaired quality of life. Minimally invasive extraperitoneal techniques have evolved to optimize midline reconstruction while avoiding intraperitoneal mesh placement, especially in the setting of diastasis recti. Preperitoneal Extended Totally Extraperitoneal (PeTEP) repair is a recently introduced approach, but evidence regarding its safety and effectiveness remains limited. Therefore, we performed a systematic review and meta-analysis to synthesize the available evidence.

METHODS

A systematic search of PubMed, Embase, and the Cochrane Library was conducted to identify studies evaluating PeTEP repair for ventral hernia with or without rectus diastasis. Meta-analytical pooling of outcomes was performed using a random-effects model. All statistical analyses were conducted using R software (version 4.4.1).

RESULTS

Four studies were included, comprising 99 patients, with a mean age of 51.53 years and a mean body mass index of 29.55 kg/m2. The pooled mean operative time was 129.48 min (95% CI 74.96 to 184.00). Hematoma occurred in 10.61% of patients (95% CI 5.14 to 20.62), and overall postoperative complications in 21.21% (95% CI 12.98 to 32.69), with no intervention required in either case. Bulging was observed in 4.88% of cases (95% CI 1.22 to 17.52). No recurrences were reported across studies, with follow-up ranging from 1 to 12 months.

CONCLUSION

Current evidence suggests that PeTEP may be a feasible minimally invasive extraperitoneal approach for ventral hernia repair. However, further comparative studies with longer follow-up are needed.