Open Intraperitoneal Onlay Mesh (IPOM) Technique for Incisional Hernia Repair

Abstract

In an Expert Consensus Guided by Systematic Review the panel agreed that for open elective incisional hernia repair sublay mesh location is preferred, but open intraperitoneal onlay mesh (IPOM) may be useful in certain settings. Accordingly, the available literature on the open IPOM technique was searched and evaluated.Material and Methods: A systematic search of the available literature was performed in July 2018 using Medline, PubMed, and the Cochrane Library. Forty-five publications were identified as relevant for the key question.Results: Compared to laparoscopic IPOM, the open IPOM technique was associated with significantly higher postoperative complication rates and recurrence rates. For the open IPOM with a bridging situation the postoperative complication rate ranges between 3.3 and 72.0% with a mean value of 20.4% demonstrating high variance, as did the recurrence rate of between 0 and 61.0% with a mean value of 12.6%. Only on evaluation of the upward-deviating maximum values and registry data is a trend toward better outcomes for the sublay technique demonstrated. Through the use of a wide mesh overlap, avoidance of dissection in the abdominal wall and defect closure it appears possible to achieve better outcomes for the open IPOM technique.Conclusion: Compared to the laparoscopic technique, open IPOM is associated with significantly poorer outcomes. For the sublay technique the outcomes are quite similar and only tendentially worse. Further studies using an optimized open IPOM technique are urgently needed.

Recurrent Incisional Hernia Repair—An Overview

“…For the open IPOM technique in incisional hernia repair a review revealed a recurrence rate of 12.6% (range 0–61%) at follow-up of 1–8.1 years (27). These outcome data based mainly on prospective and retrospective observational studies.…”

Post-Partum Abdominal Wall Insufficiency Syndrome (PPAWIS): Lessons learned from a single surgeon’s experience based on 200 cases

“…This is why the laparoscopic IPOM procedure was abandoned. Even though the results of IPOM have been reported to be valuable for ventral hernias and rectus diastasis, there are still many publications showing adhesion formation due to intraperitoneal mesh placement and postoperative pain due to the application of tackers for mesh xation (18,19). The sublay technique requires opening the rectus sheath and involves a posterior layer of the rectus muscle in the in ammatory process of mesh ingrowth.…”

Mesh and plane selection: a summary of options and outcomes

“…When evaluating overall complication rates, Sosin et al's [15] review highlights similar overall complication rates observed in ventral hernia repairs, which ranged from 32.6% to 39.1%, regardless of mesh location with no statistically significant difference (P = 0.738). While the onlay approach is generally considered the least technically challenging approach to mesh placement, it has fallen out of favor due to the reported increased wound and mesh infection complications [18] with approximately 7.6% of hernia repairs as of 2018 being performed in this plane. This is compared to greater than 65% of meshes being placed in the sublay-intraperitoneal, preperitoneal plane, or retromuscular plane in their pooled analysis of reported ventral hernia repairs [15] .…”