This video demonstrate experimental Ipom Inguinal Hernia Surgery by Suturing - Personnel Technique of Dr R K Mishra. So far we have perform 36 cases of IPOM inguinal hernia surgery with two year followup and the results are encouraging. Any long term randomized control trial is required to see the feasibility of this technique.

Inguinal hernia is one of the most common surgical conditions worldwide, traditionally treated by open repair or laparoscopic techniques such as TEP and TAPP. With advancement in minimally invasive surgery, Intraperitoneal Onlay Mesh (IPOM) repair has emerged as an alternative approach. At World Laparoscopy Hospital, Dr. R. K. Mishra has developed a refined IPOM inguinal hernia repair using a specialized suturing-based mesh fixation method, which aims to improve surgical precision, reduce postoperative pain, and enhance long-term outcomes.

Concept of IPOM Inguinal Hernia Repair
IPOM repair involves placing a prosthetic mesh inside the peritoneal cavity directly over the hernia defect. This technique allows surgeons to repair the defect with minimal tissue dissection and smaller incisions, resulting in faster recovery and less surgical trauma compared to conventional open procedures. Laparoscopic hernia surgery in general is associated with less postoperative pain, reduced hospital stay, and quicker return to daily activities.

Dr. R. K. Mishra’s Personal Suturing Technique
Dr. Mishra’s innovation focuses on intracorporeal suturing for mesh fixation rather than relying mainly on metallic tacks or glue. The key steps include minimal dissection, strategic mesh placement with adequate overlap, suturing fixation of the mesh, and proper peritoneal closure to prevent bowel adhesion. This approach ensures strong and stable mesh fixation while reducing risks such as nerve irritation, mesh migration, and chronic groin pain.

Clinical and Practical Advantages
The suturing-based IPOM technique offers multiple benefits. It is cost-effective because sutures are cheaper than fixation devices like tackers. It also reduces foreign body irritation and postoperative discomfort. Studies comparing sutures and tackers show similar recurrence rates and long-term outcomes, but sutures significantly reduce material cost and may reduce postoperative pain in many cases.
Additionally, research indicates that suture fixation can be far less expensive than tack fixation without compromising safety or effectiveness.

Role in Modern Laparoscopic Training and Practice
At World Laparoscopy Hospital, this technique is also used as a training model to teach advanced intracorporeal suturing skills. Surgeons from across the world learn this technique to improve mesh fixation quality and reduce dependence on expensive fixation devices. Patients treated using this method often report faster recovery, minimal recurrence, and reduced postoperative pain.

Limitations and Surgical Considerations
Although IPOM repair is effective, many surgeons today prefer TEP or TAPP approaches because of concerns regarding neuralgia and long-term outcomes in some studies. Therefore, the choice of technique should be individualized based on patient factors such as hernia size, recurrence status, and surgeon expertise.

Conclusion
IPOM inguinal hernia surgery by suturing represents a blend of surgical skill and minimally invasive innovation. Dr. R. K. Mishra’s personal technique emphasizes precision suturing, optimal mesh placement, and safe peritoneal closure to achieve durable and cost-effective hernia repair. As laparoscopic surgery continues to evolve, such personalized refinements contribute significantly to improving patient outcomes and surgical education worldwide.