Surgery Today

, Volume 46, Issue 7, pp 764–773 | Cite as

Closure versus non-closure of fascial defects in laparoscopic ventral and incisional hernia repairs: a review of the literature

  • Katsuhito Suwa
  • Tomoyoshi Okamoto
  • Katsuhiko Yanaga
Review Article


The laparoscopic technique for repairing ventral and incisional hernias (VIH) is now well established. However, several issues related to laparoscopic VIH repair, such as the high recurrence rate for hernias with large fascial defects and in extremely obese patients, are yet to be resolved. Additional problems include seroma formation, mesh bulging/eventration, and non-restoration of the abdominal wall rigidity/function with only bridging of the hernial orifice using standard laparoscopic intraperitoneal onlay mesh repair (sIPOM). To solve these problems, laparoscopic fascial defect closure with IPOM reinforcement (IPOM-Plus) has been introduced in the past decade, and a few studies have reported satisfactory outcomes. Although detailed techniques for fascial defect closure and handling of the mesh have been published, standardized techniques are yet to be established. We reviewed the literature on IPOM-Plus in the PubMed database and identified 16 reports in which the recurrence rate, incidence of seroma formation, and incidence of mesh bulging were 0–7.7, 0–11.4, and 0 %, respectively. Several comparison studies between sIPOM and IPOM-Plus seem to suggest that IPOM-Plus is associated with more favorable surgical outcomes; however, larger-scale studies are essential.


Ventral hernia Incisional hernia Laparoscopic repair IPOM-plus Defect closure 



The authors wish to express their sincere gratitude to Dr. Elie Chelala for the detailed explanation of the “reverse U-stitch” during the writing of this article.

Compliance with ethical standards

Conflict of interest

None of the authors has any conflict of interest to declare.


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Copyright information

© Springer Japan 2015

Authors and Affiliations

  • Katsuhito Suwa
    • 1
  • Tomoyoshi Okamoto
    • 1
  • Katsuhiko Yanaga
    • 2
  1. 1.Department of Surgery, Daisan HospitalJikei University School of MedicineKomaeJapan
  2. 2.Department of SurgeryJikei University School of MedicineMinato-kuJapan

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