This video demonstrates Laparoscopic Incisional Hernia Repair by IPOM Plus Technique and Titanized Mesh. For large incisional hernia repair, IPOM-Plus seems to be more effective than sIPOM in terms of reducing mesh bulging. Laparoscopic repair of hernia is the method of choice for all type of hernia. The laparoscopic repair of incarcerated incisional hernias is still debated in the literature. The recent EAES/EHS guidelines state that laparoscopic surgery is not contraindicated in most of the hernia and may be considered in selected patients with an incarcerated hernia.

Incisional hernia is a common complication following abdominal surgery, resulting from weakness in the fascial closure of a previous surgical incision. With advances in minimally invasive surgery, laparoscopic incisional hernia repair has become the preferred approach due to reduced postoperative pain, faster recovery, and lower wound-related complications. Among the various laparoscopic techniques, the IPOM Plus (Intraperitoneal Onlay Mesh Plus) technique combined with titanized mesh offers superior outcomes by addressing both defect closure and durable mesh reinforcement.

Understanding the IPOM Plus Technique

The IPOM Plus technique is an evolution of the conventional IPOM repair. In standard IPOM, a mesh is placed intraperitoneally to cover the hernia defect without closing the fascial gap. In contrast, IPOM Plus involves primary closure of the hernia defect using intracorporeal suturing before mesh placement. This additional step restores the abdominal wall anatomy and improves functional and cosmetic results.

Key advantages of defect closure in IPOM Plus include:

• Reduction in postoperative seroma formation

• Restoration of abdominal wall dynamics

• Lower recurrence rates

• Improved patient comfort and cosmesis

Role of Titanized Mesh

Titanized mesh is a lightweight polypropylene mesh coated with a thin layer of titanium. This innovative design combines strength with enhanced biocompatibility, making it particularly suitable for intraperitoneal placement.

Benefits of titanized mesh include:

• Excellent tissue integration

• Reduced inflammatory response

• Lower risk of mesh shrinkage

• Decreased adhesion formation

• Improved long-term durability

When used in IPOM Plus repair, titanized mesh provides robust reinforcement while maintaining flexibility and patient comfort.

Surgical Technique

After establishing pneumoperitoneum and placing trocars, adhesiolysis is performed to expose the hernia defect completely. The hernia contents are reduced, and the defect margins are clearly defined. The fascial defect is then closed laparoscopically using non-absorbable or slowly absorbable sutures, often in a continuous or interrupted fashion.

Once defect closure is completed, a suitably sized titanized mesh is introduced into the abdominal cavity. The mesh is positioned to ensure at least a 5 cm overlap beyond the defect margins. Fixation is achieved using a combination of transfascial sutures and absorbable or non-absorbable tacks, ensuring stable mesh placement and minimizing the risk of migration.

Postoperative Outcomes

Patients undergoing laparoscopic incisional hernia repair with IPOM Plus and titanized mesh typically experience:

• Reduced postoperative pain

• Early ambulation and faster recovery

• Shorter hospital stay

• Low rates of surgical site infection

• Decreased recurrence and seroma formation

Conclusion

Laparoscopic incisional hernia repair using the IPOM Plus technique with titanized mesh represents a safe, effective, and anatomically sound approach for managing incisional hernias. By combining defect closure with advanced mesh technology, this technique enhances abdominal wall restoration, improves patient outcomes, and reduces long-term complications. As surgical expertise and technology continue to evolve, IPOM Plus with titanized mesh is increasingly becoming the standard of care in minimally invasive hernia surgery.