Incisional hernia is a common complication following abdominal surgery, occurring when the integrity of the abdominal wall is compromised at a previous incision site. Patients often present with abdominal bulge, pain, or discomfort, and in severe cases, incarceration or strangulation may occur.

Intraperitoneal Onlay Mesh (IPOM) repair has emerged as a minimally invasive, effective technique for managing incisional hernias, particularly for moderate to large defects. The use of dual-layer mesh enhances repair strength, prevents adhesion formation, and reduces the risk of recurrence, making it a preferred choice in contemporary hernia surgery.

Indications

IPOM repair with dual mesh is indicated in patients with:

Symptomatic incisional hernias causing pain or discomfort

Recurrent hernias after previous open or laparoscopic repair

Large or complex hernia defects not suitable for primary closure

Patients with comorbidities who benefit from minimally invasive approaches, such as obesity or diabetes

Contraindications include untreated infection at the surgical site, severe adhesions, or inability to tolerate general anesthesia.

Preoperative Preparation

Patient Assessment:

Evaluate hernia size, location, and reducibility through clinical examination and imaging (ultrasound or CT scan).

Medical Optimization:

Manage comorbidities such as hypertension, diabetes, or obesity.

Assess coagulation profile and correct any abnormalities.

Anesthesia and Patient Counseling:

General anesthesia is preferred.

Discuss procedure, risks, postoperative care, and activity restrictions.

Surgical Technique

Dr. R. K. Mishra and other experts have refined IPOM repair for incisional hernias using dual mesh to ensure safe and durable outcomes.

Laparoscopic Access

Establish a pneumoperitoneum using a Veress needle or open (Hasson) technique.

Port placement depends on hernia location and size:

One 10–12 mm camera port

Two or more 5 mm working ports for instruments

Hernia Sac Dissection

The hernia sac is carefully dissected and adhesions released.

Hernia contents (omentum or bowel) are reduced into the abdominal cavity.

Complete reduction ensures proper mesh placement and prevents recurrence.

Dual Mesh Selection and Placement

Dual mesh is selected for intraperitoneal use:

Visceral side: Non-adhesive surface to prevent bowel adhesions

Parietal side: Porous surface promoting tissue ingrowth and strong fixation

The mesh is introduced laparoscopically and positioned to cover the defect with a minimum 3–5 cm overlap beyond the margins of the hernia.

Mesh Fixation

Secure fixation is achieved using:

Transfascial sutures for strong anchoring

Tacks or absorbable fixation devices for additional stabilization

Tension-free placement is critical to reduce recurrence and postoperative pain.

Final Inspection

Confirm proper mesh position, defect coverage, and absence of residual hernia content.

Ports are removed, and skin incisions are closed with absorbable sutures or skin adhesive.

Advantages of IPOM Repair with Dual Mesh

Minimally invasive: Small incisions lead to reduced pain and faster recovery.

Tension-free repair: Mesh reinforcement avoids excessive stress on surrounding tissues.

Reduced recurrence rates: Proper mesh overlap and fixation prevent hernia reformation.

Adhesion prevention: Dual mesh design reduces risk of bowel adhesions and fistula formation.

Shorter hospital stay: Patients often discharged within 24–48 hours.

Suitable for complex cases: Effective for large, recurrent, or multiple incisional hernias.

Postoperative Care

Early ambulation and resumption of oral intake

Pain control with oral analgesics

Monitoring for seroma, hematoma, infection, or recurrence

Avoid heavy lifting or strenuous activity for 4–6 weeks

Follow-up imaging in selected cases to confirm mesh position and healing

Outcomes

IPOM repair with dual mesh demonstrates:

High success rates with low recurrence

Reduced postoperative pain compared to open repair

Safety in high-risk patients, including obesity or comorbid conditions

Excellent long-term outcomes with minimal complications

Dr. R. K. Mishra emphasizes careful patient selection, meticulous technique, and proper mesh handling to maximize surgical success.

Conclusion

IPOM repair with dual mesh represents a safe, effective, and minimally invasive approach for managing incisional hernias.

By combining secure mesh placement, dual-layer design, and tension-free technique, surgeons can achieve excellent patient outcomes, minimal complications, and faster recovery. This approach exemplifies modern laparoscopic hernia surgery, offering durable repair and improved quality of life for patients.