Inguinal hernia repair is one of the most frequently performed procedures in general surgery. While traditional open methods have proven effective, laparoscopic techniques have transformed hernia management, offering reduced postoperative pain, faster recovery, and minimal scarring. Among laparoscopic approaches, Intraperitoneal Onlay Mesh (IPOM) repair has emerged as a reliable method, particularly in recurrent, bilateral, or complex hernias.

Dr. R. K. Mishra, a pioneer in minimally invasive surgery, has refined the IPOM technique with suture-based mesh fixation, enhancing safety, reducing recurrence, and improving patient outcomes. His personalized suturing method provides secure, tension-free repair while minimizing risks of mesh migration and chronic postoperative pain.

Indications

IPOM inguinal hernia surgery using Dr. Mishra’s suturing technique is indicated for:

Primary and recurrent inguinal hernias, especially after failed open repair

Bilateral hernias, enabling simultaneous repair

Large, complex, or multiple hernia defects

Patients with prior abdominal surgery or adhesions making preperitoneal dissection challenging

Cases where tension-free repair is crucial, particularly in active or athletic patients

Contraindications include severe intra-abdominal adhesions, uncontrolled infection, or inability to tolerate general anesthesia.

Preoperative Preparation

Clinical Evaluation: Comprehensive history, physical exam, and prior surgical history.

Imaging: Ultrasound or CT scan may be utilized in complex or recurrent hernias.

Anesthesia: General anesthesia is preferred for optimal abdominal relaxation.

Patient Positioning: Supine with slight Trendelenburg tilt to facilitate exposure.

Informed Consent: Discuss procedure, risks, benefits, and postoperative care.

Surgical Technique

Dr. Mishra’s IPOM suturing method emphasizes secure mesh fixation with minimal trauma.

Laparoscopic Access

Pneumoperitoneum is established using a Veress needle or open (Hasson) technique.

Port placement:

Umbilical 10 mm port for the camera

Two accessory 5 mm ports for instruments

Ports are positioned to allow triangulation and ease of suturing.

Hernia Sac Identification and Reduction

Hernia defect is identified laparoscopically.

Indirect hernias: Sac is reduced into the peritoneal cavity.

Direct hernias: Protruding sac is flattened, and preperitoneal fat reduced.

Careful dissection ensures avoidance of bladder, bowel, or vascular injury.

Mesh Selection and Placement

A dual-sided or composite mesh is chosen to prevent adhesion to intra-abdominal organs.

Mesh is introduced intraperitoneally and positioned over the hernia defect with at least 3–5 cm overlap beyond margins.

Proper positioning ensures coverage of the myopectineal orifice and prevents recurrence.

Suturing Technique (Dr. Mishra’s Personal Method)

Unlike standard tack fixation, Dr. Mishra uses suturing for secure mesh anchoring.

Steps:

Mesh is held in position using atraumatic graspers.

Non-absorbable or long-lasting absorbable sutures are passed laparoscopically through the abdominal wall and mesh.

Extracorporeal knots are tied and pushed into the peritoneal cavity using a knot pusher.

Multiple sutures are placed at strategic points, ensuring stable fixation without tension.

Advantages:

Minimizes mesh migration

Reduces chronic postoperative pain associated with tack fixation

Provides uniform tension-free coverage

Suitable for large or recurrent defects

Final Inspection and Closure

Mesh position and fixation are verified laparoscopically.

Pneumoperitoneum is released slowly to confirm stability.

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

Advantages of Dr. Mishra’s Suturing Technique

Secure fixation: Reduces risk of recurrence or mesh displacement.

Tension-free repair: Preserves tissue integrity and reduces pain.

Minimally invasive: Smaller incisions, faster recovery, and better cosmetic results.

Effective for complex hernias: Bilateral, large, or recurrent hernias managed efficiently.

Reduced mesh-related complications: Lower risk of adhesion or chronic groin pain.

Postoperative Care

Early ambulation and resumption of oral intake.

Pain managed with oral analgesics.

Discharge usually within 24 hours for uncomplicated cases.

Follow-up to monitor for seroma, hematoma, infection, or recurrence.

Return to routine activities within 1–2 weeks depending on recovery.

Outcomes

Dr. Mishra’s personal suturing method for IPOM inguinal hernia repair demonstrates:

Low recurrence rates due to secure and precise mesh fixation

Reduced postoperative pain compared to tack-based fixation

Rapid recovery and early return to work

Effective management of recurrent, bilateral, or complex hernias

Conclusion

IPOM inguinal hernia repair using Dr. R. K. Mishra’s personal suturing technique represents a significant advancement in laparoscopic hernia surgery. By combining secure sutured mesh fixation, tension-free repair, and minimally invasive access, it offers patients excellent long-term outcomes, minimal complications, and faster recovery.

For surgeons, mastering this technique provides the skills to manage complex, recurrent, or bilateral hernias efficiently and safely, making it a valuable addition to the repertoire of modern laparoscopic procedures.