Surgical Meshes for Hernia Reparation

The IPOM (Intraperitoneal Onlay Mesh) technique is a special repair procedure where a mesh is introduced into the abdominal cavity and placed from the inside over the hernia opening.

To conduct this IPOM technique, the first small incision is made in the scar-free abdominal wall, into which first gas is blown into the abdomen for visibility, and then the laparoscopic camera is introduced. Usually, only two additional small incisions into the abdominal wall are needed for the working instruments to complete the mesh insertion. If necessary, Dr. David W. Ford will first lyse any adhesions and then expose the contents of the hernial sac. Dr. David W. Ford always closes the hernia defect with suture using robotic assistance. This is sometimes referred to as IPOM+. This is not done by all surgeons and is a primary advantage of using robotic assistance.

Then the synthetic mesh is introduced via the incisions and unfolded over the defect in the abdominal wall. The mesh is then secured to the peritoneal side of the abdominal wall with running absorbable sutures. A special coated mesh is used since it involves the placement of mesh directly onto the peritoneum overlapping the hernia defect, in direct contact with intestines.

These mesh products were promoted to limit or prevent complications known to be associated with implantation adjacent to the intestines. The IPOM technique can only be carried out under general anesthesia.

TAPP refers to the laparoscopic technique called Transabdominal Preperitoneal Repair. eTEP, first introduced in 2012, refers to a closely related laparoscopic technique, called Extended Totally Extraperitoneal Repair. Both surgeries use a common methodology in entering the abdominal cavity and pushing tissue back through the inguinal canal but differ in their placement of the mesh that supports the abdominal wall when completing the Inguinal Hernia Repair.

Transabdominal preperitoneal (TAPP) repair and Extended Totally Extraperitoneal (eTEP) repair are the most common laparoscopic techniques for inguinal hernia repair. In TAPP the surgeon goes into the peritoneal cavity and places a mesh through a peritoneal incision over possible hernia sites. eTEP is different in that the peritoneal cavity is not entered and mesh is used to seal the hernia from outside the peritoneum (the thin membrane covering the organs in the abdomen). This approach is considered to be more difficult than TAPP but may have fewer complications because it creates a larger space to address particularly difficult and large hernias.

TAPP and eTEP have now been expanded for repair of other hernias. The advantage of these repairs over IPOM+ is that the mesh is hidden between the layers of the abdominal wall and is not in direct contact with the intestines. The disadvantages are that the repairs can be more complex and can’t be used for all hernias. Dr. David W. Ford will discuss the options of minimally invasive repair and help you to decide which repair is right for you. Not all surgeons do these more complex repairs and may not be able to offer these options to you.