A hernia occurs when an organ or fatty tissue squeezes through a weak spot in a surrounding muscle or connective tissue called fascia. Surgical intervention is the primary treatment, and one method is the Intraperitoneal Onlay Mesh (IPOM) repair. This procedure addresses certain hernias by reinforcing the abdominal wall from the inside.
The IPOM Hernia Repair Procedure
The term IPOM stands for Intraperitoneal Onlay Mesh. This procedure is performed using a minimally invasive laparoscopic approach, meaning it involves small incisions instead of one large one. The surgeon makes a few small cuts in the abdomen and inserts a tube to inflate it with carbon dioxide gas. This creates a dome-like space that gives the surgeon a clear view and room to work.
Once the abdomen is inflated, a laparoscope—a thin tube with a camera on the end—is inserted through one of the incisions. This camera transmits images to a monitor, guiding the surgeon’s movements. Specialized surgical instruments are then introduced through the other small incisions to free any tissue stuck in the hernia defect before placing a coated mesh inside to cover the opening.
The composite mesh used in IPOM repair has two sides. One side is porous to encourage tissue to grow into it, securing it to the abdominal wall. The other side has a smooth, absorbable coating to prevent organs like the intestines from sticking to it. The mesh is positioned to overlap the hernia defect and secured with surgical tacks, sutures, or glue for lasting reinforcement.
Candidates for IPOM Repair
IPOM repair is suited for certain types of hernias, primarily ventral and incisional hernias. Ventral hernias appear on the front of the abdominal wall, while incisional hernias develop at the site of a previous surgical scar, representing a failure of the fascia to heal properly. Ideal candidates have small to moderate-sized hernia defects, often less than 10 centimeters in width.
The hernia’s location and the patient’s overall health are also factors. Patients with obesity may be guided toward a laparoscopic approach like IPOM to reduce the risk of wound infections associated with open surgery. The surgeon will also assess if the hernia is incarcerated, meaning tissue is trapped inside, as this may affect the surgical approach.
This technique is not suitable for everyone. Very large hernias, where a significant portion of the abdominal organs reside outside the abdominal cavity, may require a more complex open reconstruction. Patients with extensive internal scarring from previous surgeries may also present challenges for the laparoscopic approach.
Recovery and Postoperative Care
Recovery after an IPOM hernia repair is quicker than with traditional open surgery. The hospital stay is short, often one to two days, with some patients discharged the same day. Pain is managed post-procedure, and an abdominal binder worn for the first few weeks can help reduce pain and provide support.
Activity restrictions are an important part of recovery to ensure the mesh integrates properly with the abdominal wall. Patients are advised to avoid heavy lifting and strenuous exercise for two to four weeks. Driving is restricted for the first week or two, or until the patient is off prescription pain medication. Most people return to office work and light daily activities within one to two weeks.
Care for the small incision sites involves keeping the areas clean and dry. The sutures or surgical glue used to close them often dissolve on their own. Following the surgeon’s specific instructions is necessary to minimize complications and ensure a durable repair.
Potential Complications and Outcomes
IPOM repair carries potential risks, including the formation of a seroma, which is a collection of fluid at the surgical site. While a seroma often resolves on its own, a large one might require drainage. Another risk is bowel adhesions, where scar tissue forms between the intestines and the mesh. Though uncommon, adhesions can lead to chronic pain or, in rare cases, bowel obstruction.
Infection is another risk, though the laparoscopic approach has a lower rate of wound complications than open surgery. If the mesh becomes infected, it may need to be surgically removed. Hernia recurrence can still happen, but long-term studies show low rates after IPOM repair, around 2.7% to 8%.
Long-term outcomes for IPOM repair are positive, with a low rate of mesh-related complications requiring reoperation. The technique is considered safe and effective, particularly for small- and medium-sized ventral hernias. Patients often report high satisfaction and a quick return to normal activities.