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IPOM-Plus — Intraperitoneal Onlay Mesh with Defect Closure

Laparoscopic ventral hernia repair technique that combines fascial defect closure with intraperitoneal placement of composite mesh, restoring anatomy and reducing seroma, mesh bulging, and recurrence compared with classic IPOM.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is IPOM-Plus — Intraperitoneal Onlay Mesh with Defect Closure?

IPOM (Intraperitoneal Onlay Mesh) is a laparoscopic ventral hernia repair technique placing a composite mesh inside the peritoneal cavity overlapping the defect by at least 5 cm; the visceral side has anti-adhesive coating (e.g., ePTFE, Sepra-Film, hydrogel barrier).

IPOM-Plus differs from classic IPOM by closing the fascial defect with intracorporeal continuous slowly absorbable or non-absorbable suture before mesh fixation; this restores linea alba, reduces dead space, and re-establishes abdominal wall function.

Outcomes after IPOM-Plus show lower rates of seroma (5–10% vs 20–30%), mesh bulging or pseudo-recurrence (under 5%), chronic pain, and recurrence (3–7% at 5 years) compared with classic IPOM in randomized and registry data.

Symptoms

Suitable for ventral hernia (umbilical, epigastric, primary midline) and incisional hernia with defect 2–8 cm width on imaging or examination
Visible or palpable midline bulge, diastasis recti accompaniment, intermittent or constant abdominal discomfort
History of prior abdominal surgery with incisional hernia at site, particularly in obese, diabetic, smoker, or post-emergency-laparotomy patients
Symptoms include pain, dragging sensation, cosmetic concern, and rarely incarceration with severe pain, vomiting, or strangulation
Risk of mesh bulging in classic IPOM addressed by IPOM-Plus closure approach
Tolerable for laparoscopic surgery (ASA 1–3, BMI typically under 40, no severe COPD)

Risk Factors

Body mass index over 30 — higher recurrence and complication rates
Diabetes mellitus, smoking, malnutrition — wound healing impairment
Prior multiple abdominal operations, prior mesh repair, contaminated field
Defect size over 10 cm width — TAR or open complex repair often preferred
Connective tissue disorders (Marfan, Ehlers-Danlos), severe abdominal wall loss
Hemorrhagic risk (anticoagulation), severe cardiopulmonary comorbidity unsuitable for pneumoperitoneum

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Symptomatic primary or incisional ventral hernia with defect 2–8 cm — surgical evaluation for IPOM-Plus or alternative
  • Acute incarceration with pain, vomiting, irreducibility — emergency surgery to prevent strangulation
  • Recurrent hernia after prior repair — specialist evaluation including TAR, Rives-Stoppa, eTEP options
  • Severe BMI elevation — pre-operative weight optimization clinic referral
  • Persistent pain or recurrence after IPOM — imaging with CT or MRI and reoperation planning

Treatment Methods

01
Preoperative optimization: smoking cessation 4–8 weeks, glycemic control HbA1c under 7%, weight reduction if BMI over 35, nutrition optimization
02
IPOM-Plus operative steps: pneumoperitoneum, adhesiolysis, defect measurement, intracorporeal continuous suture closure of fascial defect with non-absorbable or slowly-absorbable monofilament, then mesh placement with overlap ≥5 cm in all directions
03
Mesh fixation by tackers, transfascial sutures, or absorbable tackers; some studies favor double crown plus transfascial sutures or self-fixating mesh
04
Postoperative care: abdominal binder for 4–6 weeks, no heavy lifting for 6 weeks, early ambulation, multimodal analgesia, DVT prophylaxis
05
Follow-up: clinical exam at 4 weeks, 3 months, and annually; CT/MRI if recurrence or pain suspected; long-term registry participation when available

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.