Abstract
Purpose
Ventral hernia repair has become a common procedure, but the way in which it is performed still depends on surgeon’s skill, experience, and habit. The initial open approach is faced with extensive dissection and a high risk of infection and prolonged hospital stay. To tackle these problems, minimally invasive procedures are gaining interest. Several new techniques are emerging, but laparoscopic intra-peritoneal onlay mesh (IPOM) is still the mainstay for many surgeons. We will discuss why laparoscopic IPOM is still a valuable approach in the treatment of primary non-complicated midline hernias and review the current literature.
Methods
We performed a literature search across PubMed and MEDLINE using the following search terms: “Laparoscopic hernia repair”, “Ventral hernia repair” and “Primary ventral hernia”. Articles corresponding to these search terms were individually reviewed by the primary author and selected on relevance.
Conclusion
Laparoscopic IPOM still is a good approach for the efficient treatment of primary non-complicated midline hernias. Several techniques are emerging, but are faced with increased costs, technical difficulties, and low study patient volume. Further research is warranted to show superiority and applicability of these new techniques over laparoscopic IPOM, but until then laparoscopic IPOM should remain the go-to technique.
Similar content being viewed by others
References
Muysoms FE, Miserez M, Berrevoet F et al (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13:407–414. https://doi.org/10.1007/s10029-009-0518-x
Coste AHPJ (2019) Umbilical hernia. In: StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK459312/. Accessed 19 Aug 2019
Zens T, Nichol PF, Cartmill R, Kohler JE (2017) Management of asymptomatic pediatric umbilical hernias: a systematic review. J Pediatr Surg 52:1723–1731. https://doi.org/10.1016/j.jpedsurg.2017.07.016
Ponten JEH, Thomassen I, Nienhuijs SW (2014) A collective review on mesh-based repair of umbilical and epigastric hernias. Indian J Surg 76:371–377. https://doi.org/10.1007/s12262-013-0920-6
Ponten JEH, Somers KYA, Nienhuijs SW (2012) Pathogenesis of the epigastric hernia. Hernia 16:627–633. https://doi.org/10.1007/s10029-012-0964-8
Faylona JM (2017) Evolution of ventral hernia repair. Asian J Endosc Surg 10:252–258. https://doi.org/10.1111/ases.12392
Lindmark M, Strigård K, Löwenmark T et al (2018) Risk factors for surgical complications in ventral hernia repair. World J Surg 42:3528–3536. https://doi.org/10.1007/s00268-018-4642-6
Sharma A, Khullar R, Soni V et al (2013) Iatrogenic enterotomy in laparoscopic ventral/incisional hernia repair: a single center experience of 2,346 patients over 17 years. Hernia 17:581–587. https://doi.org/10.1007/s10029-013-1122-7
Suwa K, Okamoto T, Yanaga K (2016) Closure versus non-closure of fascial defects in laparoscopic ventral and incisional hernia repairs: a review of the literature. Surg Today 46:764–773. https://doi.org/10.1007/s00595-015-1219-y
Kroese LF, Gillion JF, Jeekel J et al (2018) Identification of risk factors for 30-day postoperative complications in patients undergoing primary ventral hernia repair: a prospective cohort study of 2,374 patients. Surg (US) 163:1160–1164. https://doi.org/10.1016/j.surg.2017.12.019
Liang MK, Holihan JL, Itani K et al (2016) Ventral hernia management. Ann Surg 265:80–89. https://doi.org/10.1097/sla.0000000000001701
Nguyen MT, Berger RL, Hicks SC et al (2014) Comparison of outcomes of synthetic mesh vs suture repair of elective primary ventral herniorrhaphy: a systematic review and meta-analysis. JAMA Surg 149:415–421. https://doi.org/10.1001/jamasurg.2013.5014
Mathes T, Walgenbach M, Siegel R (2016) Suture versus mesh repair in primary and incisional ventral hernias: a systematic review and meta-analysis. World J Surg 40:826–835. https://doi.org/10.1007/s00268-015-3311-2
Aslani N, Brown CJ (2010) Does mesh offer an advantage over tissue in the open repair of umbilical hernias? A systematic review and meta-analysis. Hernia 14:455–462. https://doi.org/10.1007/s10029-010-0705-9
Christoffersen MW, Helgstrand F, Rosenberg J et al (2015) Long-term recurrence and chronic pain after repair for small umbilical or epigastric hernias: a regional cohort study. Am J Surg 209:725–732. https://doi.org/10.1016/j.amjsurg.2014.05.021
Holihan JL, Hannon C, Goodenough C et al (2017) Ventral hernia repair: a meta-analysis of randomized controlled trials. Surg Infect (Larchmt) 18:647–658. https://doi.org/10.1089/sur.2017.029
Sosin M, Nahabedian MY, Bhanot P (2018) The perfect plane: a systematic review of mesh location and outcomes, update 2018. Plast Reconstr Surg 142:107S–116S. https://doi.org/10.1097/PRS.0000000000004864
Ponten JEH, Leclercq WKG, Lettinga T et al (2018) Mesh OR patch for hernia on epigastric and umbilical sites (MORPHEUS-Trial). Ann Surg. https://doi.org/10.1097/sla.0000000000003086
Shankar DA, Itani KMF, O’Brien WJ, Sanchez VM (2017) Factors associated with long-term outcomes of umbilical hernia repair. JAMA Surg 152:461–466. https://doi.org/10.1001/jamasurg.2016.5052
Holihan JL, Nguyen DH, Nguyen MT et al (2016) Mesh location in open ventral hernia repair: a systematic review and network meta-analysis. World J Surg 40:89–99. https://doi.org/10.1007/s00268-015-3252-9
Albino FP, Patel KM, Nahabedian MY et al (2013) Does mesh location matter in abdominal wall reconstruction? A systematic review of the literature and a summary of recommendations. Plast Reconstr Surg 132:1295–1304. https://doi.org/10.1097/PRS.0b013e3182a4c393
Holihan JL, Bondre I, Askenasy EP et al (2016) Sublay versus underlay in open ventral hernia repair. J Surg Res 202:26–32. https://doi.org/10.1016/j.jss.2015.12.014
Misiakos EP, Patapis P, Zavras N et al (2015) Current trends in laparoscopic ventral hernia repair. JSLS J Soc Laparoendosc Surg 19(e2015):00048. https://doi.org/10.4293/jsls.2015.00048
Rajkumar J, Chopra P, Chintamani (2015) Basic physics revisited for a surgeon. Indian J Surg 77:169–175. https://doi.org/10.1007/s12262-015-1308-6
Ahmed MA, Tawfic QA, Schlachta CM, Alkhamesi NA (2018) Pain and surgical outcomes reporting after laparoscopic ventral hernia repair in relation to mesh fixation technique: a systematic review and meta-analysis of randomized clinical trials. J Laparoendosc Adv Surg Tech 28:1298–1315. https://doi.org/10.1089/lap.2017.0609
Reynvoet E, Deschepper E, Rogiers X et al (2014) Laparoscopic ventral hernia repair: is there an optimal mesh fixation technique? A systematic review. Langenbeck’s Arch Surg 399:55–63. https://doi.org/10.1007/s00423-013-1126-x
Leber GE, Garb JL, Alexander AI, Reed WP (1998) Long-term complications associated with prosthetic repair of incisional hernias. Arch Surg 133:378–382. https://doi.org/10.1001/archsurg.133.4.378
Matthews BD, Pratt BL, Pollinger HS et al (2003) Assessment of adhesion formation to intra-abdominal polypropylene mesh and polytetrafluoroethylene mesh. J Surg Res 114:126–132. https://doi.org/10.1016/S0022-4804(03)00158-6
D’Amore L, Ceci F, Mattia S et al (2017) Adhesion prevention in ventral hernia repair: an experimental study comparing three lightweight porous meshes recommended for intraperitoneal use. Hernia 21:115–123. https://doi.org/10.1007/s10029-016-1541-3
Köckerling F, Simon T, Adolf D et al (2019) Laparoscopic IPOM versus open sublay technique for elective incisional hernia repair: a registry-based, propensity score-matched comparison of 9907 patients. Surg Endosc. https://doi.org/10.1007/s00464-018-06629-2
Bittner R, Bingener-Casey J, Dietz U et al (2014) Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society [IEHS])—Part 2. Surg Endosc 28:353–379. https://doi.org/10.1007/s00464-013-3171-5
Mercoli H, Tzedakis S, D’Urso A et al (2017) Postoperative complications as an independent risk factor for recurrence after laparoscopic ventral hernia repair: a prospective study of 417 patients with long-term follow-up. Surg Endosc 31:1469–1477. https://doi.org/10.1007/s00464-016-5140-2
LeBlanc KA, Booth WV (1993) Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc 3:39–41
Tandon A, Pathak S, Lyons NJR et al (2016) Meta-analysis of closure of the fascial defect during laparoscopic incisional and ventral hernia repair. Br J Surg 103:1598–1607. https://doi.org/10.1002/bjs.10268
Martin-del-Campo LA, Miller HJ, Elliott HL, Novitsky YW (2018) Laparoscopic ventral hernia repair with and without defect closure: comparative analysis of a single-institution experience with 783 patients. Hernia 22:1061–1065. https://doi.org/10.1007/s10029-018-1812-2
Wiessner R, Vorwerk T, Tolla-Jensen C, Gehring A (2017) Continuous laparoscopic closure of the linea alba with barbed sutures combined with laparoscopic mesh implantation (IPOM plus repair) as a new technique for treatment of abdominal hernias. Front Surg 4:1–6. https://doi.org/10.3389/fsurg.2017.00062
Ahonen-Siirtola M, Nevala T, Vironen J et al (2019) Laparoscopic versus hybrid approach for treatment of incisional ventral hernia: a prospective randomised multicentre study, 1-year results. Surg Endosc. https://doi.org/10.1007/s00464-019-06735-9
Moreno-Egea A, Campillo-Soto Á, Morales-Cuenca G (2015) Which should be the gold standard laparoscopic technique for handling Spigelian hernias? Surg Endosc 29:856–862. https://doi.org/10.1007/s00464-014-3738-9
Clapp ML, Hicks SC, Awad SS, Liang MK (2013) Trans-cutaneous closure of central defects (TCCD) in laparoscopic ventral hernia repairs (LVHR). World J Surg 37:42–51. https://doi.org/10.1007/s00268-012-1810-y
Lambrecht JR, Vaktskjold A, Trondsen E et al (2015) Laparoscopic ventral hernia repair: outcomes in primary versus incisional hernias: no effect of defect closure. Hernia 19:479–486. https://doi.org/10.1007/s10029-015-1345-x
Pham CT, Perera CL, Scott Watkin D, Maddern GJ (2009) Laparoscopic ventral hernia repair: a systematic review. Surg Endosc Other Interv Tech 23:4–15. https://doi.org/10.1007/s00464-008-0182-8
Castro PMV, Rabelato JT, Monteiro GGR et al (2014) Laparoscopy versus Laparotomy in the repair of ventral hernias: systematic review and meta-analysis. Arq Gastroenterol 51:205–211. https://doi.org/10.1590/s0004-2803201400030008
Liang MK, Berger RL, Li LT et al (2013) Outcomes of laparoscopic vs open repair of primary ventral hernias. JAMA Surg 148:1043–1048. https://doi.org/10.1001/jamasurg.2013.3587
Sauerland S, Walgenbach M, Habermalz B et al (2011) Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD007781.pub2
Yang GPC (2017) From intraperitoneal onlay mesh repair to preperitoneal onlay mesh repair. Asian J Endosc Surg 10:119–127. https://doi.org/10.1111/ases.12388
Jin J, Rosen MJ (2008) Laparoscopic versus open ventral hernia repair. Surg Clin N Am 88:1083–1100. https://doi.org/10.1016/j.suc.2008.05.015
Al Chalabi H, Larkin J, Mehigan B, McCormick P (2015) A systematic review of laparoscopic versus open abdominal incisional hernia repair, with meta-analysis of randomized controlled trials. Int J Surg 20:65–74. https://doi.org/10.1016/j.ijsu.2015.05.050
Hajibandeh S, Hajibandeh S, Sreh A et al (2017) Laparoscopic versus open umbilical or paraumbilical hernia repair: a systematic review and meta-analysis. Hernia 21:905–916. https://doi.org/10.1007/s10029-017-1683-y
Lomanto D, Iyer SG, Shabbir A, Cheah WK (2006) Laparoscopic versus open ventral hernia mesh repair: a prospective study. Surg Endosc Other Interv Tech 20:1030–1035. https://doi.org/10.1007/s00464-005-0554-2
Zhang Y, Zhou H, Chai Y et al (2014) Laparoscopic versus open incisional and ventral hernia repair: a systematic review and meta-analysis. World J Surg 38:2233–2240. https://doi.org/10.1007/s00268-014-2578-z
Schroeder AD, Debus ES, Schroeder M, Reinpold WMJ (2013) Laparoscopic transperitoneal sublay mesh repair: a new technique for the cure of ventral and incisional hernias. Surg Endosc 27:648–654. https://doi.org/10.1007/s00464-012-2508-9
Muysoms F, Van Cleven S, Pletinckx P et al (2018) Robotic transabdominal retromuscular umbilical prosthetic hernia repair (TARUP): observational study on the operative time during the learning curve. Hernia 22:1101–1111. https://doi.org/10.1007/s10029-018-1825-x
Baig SJ, Priya P (2018) Extended totally extraperitoneal repair (eTEP) for ventral hernias: short-term results from a single centre. J Minim Access Surg. https://doi.org/10.4103/jmas.JMAS_29_18
Reinpold W, Schröder M, Berger C et al (2018) Mini- or less-open sublay operation (MILOS). Ann Surg 269:748–755. https://doi.org/10.1097/sla.0000000000002661
Luque JAB, Luque JAB (2014) Advances in laparoscopy of the abdominal wall hernia, pp 1–211. https://doi.org/10.1007/978-1-4471-4700-8
Nguyen DH, Nguyen MT, Askenasy EP et al (2014) Primary fascial closure with laparoscopic ventral hernia repair: systematic review. World J Surg 38:3097–3104. https://doi.org/10.1007/s00268-014-2722-9
Ramakrishna HK, Lakshman K (2013) Intra peritoneal polypropylene mesh and newer meshes in ventral hernia repair: what EBM says? Indian J Surg 75:346–351. https://doi.org/10.1007/s12262-012-0743-x
Darehzereshki A, Goldfarb M, Zehetner J et al (2014) Biologic versus nonbiologic mesh in ventral hernia repair: a systematic review and meta-analysis. World J Surg 38:40–50. https://doi.org/10.1007/s00268-013-2232-1
de Biondo-Simões MLP, de Pessini VCA, Porto PHC, Robes RR (2018) Aderências em telas de polipropileno versus telas Sepramesh®: estudo experimental em ratos. Rev Col Bras Cir 45:1–11. https://doi.org/10.1590/0100-6991e-20182040
Tollens T, Den Hondt M, Devroe K et al (2011) Retrospective analysis of umbilical, epigastric, and small incisional hernia repair using the VentralexTM hernia patch. Hernia 15:531–540. https://doi.org/10.1007/s10029-011-0816-y
Nicolau AE, Vasile R, Haiducu C (2019) Laparoscopic repair of small ventral hernias using the “Ventralex Hernia Patch”. Chirurgia (Bucur) 114:95. https://doi.org/10.21614/chirurgia.114.1.95
Martin DF, Williams RF, Mulrooney T, Voeller GR (2008) Ventralex mesh in umbilical/epigastric hernia repairs: clinical outcomes and complications. Hernia 12:379–383. https://doi.org/10.1007/s10029-008-0351-7
Alizai PH, Andert A, Lelaona E et al (2017) Impact of obesity on postoperative complications after laparoscopic and open incisional hernia repair—a prospective cohort study. Int J Surg 48:220–224. https://doi.org/10.1016/j.ijsu.2017.11.006
De Jong A, Verzilli D, Geniez M et al (2018) Why is the morbidly obese patient at high risk of anesthetic complications? Press Medicale 47:453–463. https://doi.org/10.1016/j.lpm.2018.01.016
Brahmbhatt R, Carter SA, Hicks SC et al (2014) Identifying risk factors for surgical site complications after laparoscopic ventral hernia repair: evaluation of the ventral hernia working group grading system. Surg Infect (Larchmt) 15:187–193. https://doi.org/10.1089/sur.2012.179
Newcomb WL, Polhill JL, Chen AY et al (2008) Staged hernia repair preceded by gastric bypass for the treatment of morbidly obese patients with complex ventral hernias. Hernia 12:465–469. https://doi.org/10.1007/s10029-008-0381-1
Eid GM, Wikiel KJ, Entabi F, Saleem M (2013) Ventral hernias in morbidly obese patients: a suggested algorithm for operative repair. Obes Surg 23:703–709. https://doi.org/10.1007/s11695-013-0883-5
Tobler WD, Itani KMF (2016) Current status and challenges of laparoscopy in ventral hernia repair. J Laparoendosc Adv Surg Tech 26:281–289. https://doi.org/10.1089/lap.2016.0095
DeLancey JO, Blay E, Hewitt DB et al (2018) The effect of smoking on 30-day outcomes in elective hernia repair. Am J Surg 216:471–474. https://doi.org/10.1016/j.amjsurg.2018.03.004
Weiss S, Weissenbacher A, Sucher R et al (2015) Outcome analysis of laparoscopic incisional hernia repair and risk factors for hernia recurrence in liver transplant patients. Clin Transplant 29:866–871. https://doi.org/10.1111/ctr.12558
Subramanian A, Clapp ML, Hicks SC et al (2013) Laparoscopic ventral hernia repair: primary versus secondary hernias. J Surg Res 181:e1–e5. https://doi.org/10.1016/j.jss.2012.06.028
Liot E, Bréguet R, Piguet V et al (2017) Evaluation of port site hernias, chronic pain and recurrence rates after laparoscopic ventral hernia repair: a monocentric long-term study. Hernia 21:917–923. https://doi.org/10.1007/s10029-017-1663-2
Penchev D, Kotashev G, Mutafchiyski V (2019) Endoscopic enhanced-view totally extraperitoneal retromuscular approach for ventral hernia repair. Surg Endosc. https://doi.org/10.1007/s00464-019-06669-2
Belyansky I, Daes J, Radu VG et al (2018) A novel approach using the enhanced-view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair. Surg Endosc 32:1525–1532. https://doi.org/10.1007/s00464-017-5840-2
Henriksen NA, Jensen KK, Muysoms F (2019) Robot-assisted abdominal wall surgery: a systematic review of the literature and meta-analysis. Hernia 23:17–27. https://doi.org/10.1007/s10029-018-1872-3
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have no conflicts of interest with regard to this paper.
Ethical approval
This study did not require approval from the local ethical committee.
Human and animal rights
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent
Formal consent was not required for this study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Van Hoef, S., Tollens, T. Primary non-complicated midline ventral hernia: is laparoscopic IPOM still a reasonable approach?. Hernia 23, 915–925 (2019). https://doi.org/10.1007/s10029-019-02031-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10029-019-02031-6