This video demonstrate IPOM plus method is currently regarded as the best surgical procedure for umbilical hernia repair. The IPOM and IPOM plus methods can both be performed either by open surgery or laparoscopically, but the incisional wound is much larger in purely open surgery.

Incisional hernia is a common postoperative complication that occurs when abdominal wall weakness develops at the site of a previous surgical incision. With advances in minimal access surgery, laparoscopic techniques have become the preferred choice for managing incisional hernias due to reduced pain, faster recovery, and improved cosmetic outcomes. Among these techniques, the Intraperitoneal Onlay Mesh Plus (IPOM Plus) method has emerged as a significant evolution of standard IPOM repair. At World Laparoscopy Hospital (WLH), this technique is taught and practiced with emphasis on precision, patient safety, and evidence-based surgical outcomes.

Concept of IPOM Plus Technique

Traditional IPOM involves placing a mesh intraperitoneally over the hernia defect without closing the defect. IPOM Plus improves upon this by closing the fascial defect before mesh placement, thereby restoring abdominal wall anatomy and function.

Clinical research demonstrates that IPOM Plus reduces recurrence, seroma formation, and mesh bulging compared to standard IPOM repair. Studies involving more than 1,500 patients show significantly lower recurrence and complication rates, establishing IPOM Plus as a safe and effective procedure.

Indications for IPOM Plus Repair

At World Laparoscopy Hospital, IPOM Plus is commonly indicated for:

• Incisional hernias

• Ventral hernias

• Recurrent hernias

• Defects typically between 2–8 cm (depending on surgeon expertise and patient factors)

Studies show that IPOM Plus can even extend indications to larger defects when combined with additional techniques such as component separation.

Preoperative Evaluation

Patients undergo detailed evaluation including:

• Clinical examination

• Ultrasound or CT scan to assess defect size and contents

• Assessment of comorbidities (obesity, diabetes, smoking history)

Accurate imaging helps in planning mesh size, fixation method, and need for adhesiolysis.

Surgical Technique – Step by Step

At WLH, the procedure is performed under general anesthesia using standard laparoscopic principles:

1. Patient Positioning and Port Placement

• Supine position

• Pneumoperitoneum creation

• Strategic port placement away from scar area

2. Diagnostic Laparoscopy and Adhesiolysis

• Identification of hernia defect

• Careful adhesiolysis to free bowel or omentum

3. Fascial Defect Closure (Key Step of IPOM Plus)

• Intracorporeal suturing using non-absorbable or barbed sutures

• Restoration of abdominal wall continuity

4. Mesh Placement

• Composite mesh placed intraperitoneally

• Adequate overlap (usually 3–5 cm beyond defect margins)

5. Mesh Fixation

• Combination of transfascial sutures and tacks

Clinical Outcomes and Benefits

Clinical studies have reported excellent results with IPOM Plus repair:

• Low recurrence rates (as low as ~2–3% in some series)

• Reduced seroma formation

• Short hospital stay (1–4 days average)

• Minimal postoperative pain

• Faster return to normal activity

Multiple studies confirm low complication rates and high patient satisfaction with this approach.

Complications

Although safe, potential complications include:

• Seroma formation

• Surgical site infection

• Postoperative ileus

• Rare bowel injury during adhesiolysis

However, comparative studies show IPOM Plus significantly lowers seroma and recurrence compared to standard IPOM repair.

Advantages of IPOM Plus at World Laparoscopy Hospital

WLH focuses on:

• Advanced intracorporeal suturing skills

• Evidence-based mesh selection

• Standardized laparoscopic protocols

• Hands-on training for surgeons worldwide

The structured training ensures surgeons can safely perform complex hernia repairs using modern techniques.

Postoperative Care

Patients are usually:

• Mobilized early

• Discharged within a few days

• Advised gradual return to heavy activity over weeks

Future of IPOM Plus Technique

With advancements in robotic surgery and improved mesh technology, IPOM Plus continues to evolve. The technique is now considered a preferred minimally invasive option for many ventral and incisional hernias.

Conclusion

Laparoscopic Incisional Hernia Repair using the IPOM Plus technique represents a major advancement in abdominal wall surgery. By combining defect closure with mesh reinforcement, it provides superior anatomical repair, reduced recurrence, and improved patient outcomes. At World Laparoscopy Hospital, this technique is integrated into advanced laparoscopic training programs, helping surgeons deliver world-class hernia care.