This video demonstrate Laparoscopic Incisional Hernia IPOM Repair with Dual Mesh (Polyurathane Mesh) by Dr R K Mishra at World Laparoscopy Hospital. The goals of ventral hernia repair are relief of patient symptoms and/or cure of the hernia with minimization of recurrence rates. While laparoscopic ventral hernia repair (LVHR) has gained popularity in recent years, there is still significant controversy about the optimal approach to ventral hernia repair. This document has been written to assist surgeons utilizing a laparoscopic approach to ventral hernia repair in terms of patient selection, operative technique, and postoperative care. It is not intended to debate the merits of prosthetic use and specific types of prosthetics. It is important to consider the size of the hernia defect when contemplating a laparoscopic approach, as larger defects generally increase the difficulty of the procedure. A recently published guideline by an Italian Consensus Conference recommended caution for defects greater than 10cm but did not consider such defects as absolute contraindication. Currently, there are two main categories of fixation methods available for use in the operating room – tacks and sutures, both of which are available in absorbable or permanent varieties. Sutures are commonly anchored to the mesh with conventional instruments in combination with a suture-passing device. Tacks are usually deployed via a mechanical device typically referred to as a “tacker” (deploys a variety of anchoring devices collectively known as “tacks”). There are human and laboratory reports utilizing fibrin-based sealant for fixation during LVHR, but the available evidence is limited. Proponents of tacks-only fixation have cited the shorter operating time, fewer skin incisions, improved cosmesis, and less acute and chronic pain as the main advantages of this approach.

Incisional hernias are a common postoperative complication, often occurring at the site of previous abdominal surgeries. These hernias result from a weakness in the abdominal wall, allowing internal organs or tissues to protrude through the incision site. With advances in minimally invasive surgery, the Intraperitoneal Onlay Mesh (IPOM) repair with dual mesh has emerged as a gold standard treatment for many patients, offering reduced recurrence rates, faster recovery, and minimal postoperative complications.

Understanding Incisional Hernia

An incisional hernia develops when the integrity of a previous surgical scar weakens, creating a gap in the abdominal wall. Risk factors include obesity, poor wound healing, infection at the surgical site, multiple previous surgeries, and conditions that increase intra-abdominal pressure, such as chronic cough or heavy lifting.

Symptoms often include:

• A visible bulge at the surgical site

• Discomfort or pain during movement

• Nausea or digestive disturbances in severe cases

Left untreated, incisional hernias can lead to serious complications, including bowel obstruction or strangulation.

What is IPOM Repair?

IPOM (Intraperitoneal Onlay Mesh) repair is a laparoscopic technique used to treat incisional hernias. Unlike traditional open surgery, IPOM repair is minimally invasive, involving small keyhole incisions and the placement of a mesh inside the abdominal cavity. This mesh reinforces the abdominal wall, reducing tension and the risk of recurrence.

Role of Dual Mesh in IPOM Repair

The dual mesh is a specialized type of surgical mesh designed for intraperitoneal placement. It has two key features:

1. Visceral-friendly surface: The side facing the intestines is coated with a material that minimizes adhesion formation, preventing complications such as bowel obstruction or fistula.

2. Parietal attachment surface: The side facing the abdominal wall promotes tissue ingrowth, ensuring a secure and durable fixation.

Dual mesh is available in various shapes and sizes and can be tailored to the hernia defect, making it ideal for complex or recurrent incisional hernias.

Surgical Procedure

The IPOM repair with dual mesh typically involves the following steps:

1. Patient Preparation: The patient is positioned under general anesthesia, and the abdomen is prepped for a sterile laparoscopic procedure.

2. Laparoscopic Access: Small incisions are made, and a laparoscope is introduced to visualize the hernia defect and surrounding structures.

3. Adhesiolysis: Any adhesions or scar tissue inside the abdomen are carefully released to provide a clear surgical field.

4. Hernia Reduction: The herniated tissue or organs are gently returned to their normal position within the abdominal cavity.

5. Mesh Placement: A dual mesh is introduced through a trocar and positioned over the hernia defect, ensuring adequate overlap (usually 3–5 cm) beyond the edges of the defect.

6. Mesh Fixation: The mesh is secured using sutures, tacks, or a combination of both, ensuring it remains in place and reinforces the abdominal wall.

7. Closure: The small incisions are closed, and the patient is taken to recovery.

Advantages of IPOM with Dual Mesh

• Minimally invasive: Reduced postoperative pain and shorter hospital stay.

• Lower recurrence rates: The dual mesh provides strong reinforcement.

• Reduced adhesion risk: Special coating prevents intestines from sticking to the mesh.

• Faster recovery: Patients typically resume normal activities sooner than after open surgery.

• Cosmetic benefit: Smaller incisions mean minimal scarring.

Postoperative Care

• Early mobilization: Encouraged to prevent complications like blood clots.

• Pain management: Typically managed with oral analgesics.

• Diet: Normal diet can usually be resumed gradually.

• Activity restriction: Heavy lifting should be avoided for several weeks.

• Follow-up: Regular check-ups to monitor for recurrence or complications.

Conclusion

Incisional hernia IPOM repair with dual mesh represents a significant advancement in hernia surgery, combining the benefits of minimally invasive techniques with the durability of modern mesh technology. For patients suffering from incisional hernias, this procedure offers a safe, effective, and cosmetically favorable solution, reducing recurrence and improving quality of life.