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Updated: Oct 12, 2025
Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair
Published on: December 23, 2022
Intraperitoneal versus extraperitoneal mesh in minimally invasive ventral hernia repair: a systematic review and
M Yeow1, S Wijerathne2,3, D Lomanto4,5
1Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Purpose:
The ideal location for mesh placement in minimally invasive ventral hernia repair (VHR) is still up for debate. We undertook a systematic review and meta-analysis (SRMA) to evaluate the outcomes of patients who received intraperitoneal mesh versus those that received extraperitoneal mesh in minimally invasive VHR.
Methods:
We searched PubMed, EMBASE, Cochrane, and Scopus from inception to May 3, 2021. We selected studies comparing intraperitoneal mesh versus extraperitoneal mesh placement in minimally invasive VHR. A meta-analysis was done for the outcomes of surgical site infection (SSI), seroma, hematoma, readmission, and recurrence. A subgroup analysis was conducted for a subset of studies comparing patients who have undergone intraperitoneal onlay mesh (IPOM) versus extended totally extraperitoneal approach (e-TEP).
Results:
A total of 11 studies (2320 patients) were identified. We found no statistically significant difference between patients who received intraperitoneal versus extraperitoneal mesh for outcomes of SSI, seroma, hematoma, readmission, and recurrence [(RR 1.60, 95% CI 0.60-4.27), (RR 1.39, 95% CI 0.68-2.81), (RR 1.29, 95% CI 0.45-3.72), (RR 1.40, 95% CI 0.69-2.86), and (RR 1.22, 95% CI 0.22-6.63), respectively]. The subgroup analysis had findings similar to the overall analysis.
Conclusion:
Based on short-term results, extraperitoneal mesh does not appear to be superior to intraperitoneal mesh in minimally invasive ventral hernia repair. The choice of mesh location should be based on the current evidence, surgeon, and center experience as well as individualized to each patient.
Insights
For minimally invasive ventral hernia repair, neither intraperitoneal nor extraperitoneal mesh placement showed a significant difference in outcomes. Patient factors and surgeon experience should guide mesh location choice in hernia repair.
Area of Science:
- Abdominal Surgery
- Surgical Innovation
- Hernia Repair Techniques
Background:
- The optimal mesh placement for minimally invasive ventral hernia repair (VHR) remains a subject of ongoing discussion among surgeons.
- Understanding the comparative outcomes of different mesh locations is crucial for improving patient care and surgical decision-making.
Purpose of the Study:
- To systematically review and meta-analyze the outcomes of intraperitoneal versus extraperitoneal mesh placement in minimally invasive VHR.
- To compare key complications such as surgical site infection, seroma, hematoma, readmission, and recurrence between the two mesh placement techniques.
Main Methods:
- A comprehensive literature search was conducted across PubMed, EMBASE, Cochrane, and Scopus databases up to May 2021.
- Eleven studies involving 2320 patients were included, comparing intraperitoneal and extraperitoneal mesh placement in minimally invasive VHR.
- Meta-analysis was performed on outcomes including surgical site infection (SSI), seroma, hematoma, readmission, and recurrence, with a subgroup analysis for IPOM versus e-TEP.
Main Results:
- No statistically significant differences were observed between intraperitoneal and extraperitoneal mesh placement for SSI, seroma, hematoma, readmission, or recurrence.
- The calculated risk ratios (RR) and 95% confidence intervals (CI) did not indicate a significant advantage for either approach across the evaluated outcomes.
- Subgroup analysis comparing intraperitoneal onlay mesh (IPOM) with the extended totally extraperitoneal approach (e-TEP) yielded similar results to the overall analysis.
Conclusions:
- Short-term results suggest that extraperitoneal mesh placement is not superior to intraperitoneal mesh placement in minimally invasive VHR.
- The selection of mesh location should be guided by existing evidence, surgeon expertise, center experience, and individual patient characteristics.
- Further research may be warranted to explore long-term outcomes and refine best practices for mesh placement in VHR.
