Related Experiment Video
Updated: Jul 1, 2025
Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair
Published on: December 23, 2022
Long-term mesh-related complications from minimally invasive intraperitoneal onlay mesh for small to medium-sized
Sara M Maskal1, Ryan C Ellis2, Ouen Mali2
1Center for Abdominal Core Health, Cleveland Clinic, 2049 E 100th St, Desk A-100, Cleveland, OH, 44106, USA. Maskals2@ccf.org.
Introduction:
Intraperitoneal onlay mesh (IPOM) placement for small to medium-sized hernias has garnered negative attention due to perceived long-term risk of mesh-related complications. However, sparse data exists supporting such claims after minimally invasive (MIS) IPOM repairs and most is hindered by the lack of long-term follow-up. We sought to report long-term outcomes and mesh-related complications of MIS IPOM ventral hernia repairs.
Methods And Procedures:
Adult patients who underwent MIS IPOM ventral hernia repair at our institution were identified in the Abdominal Core Health Quality Collaborative database from October 2013 to October 2020. Outcomes included hernia recurrence and mesh-related complications or reoperations up to 6 years postoperatively.
Results:
A total of 325 patients were identified. The majority (97.2%) of cases were elective, non-recurrent (74.5%), and CDC class I (99.4%). Mean hernia width was 4.16 ± 3.86 cm. Median follow-up was 3.6 (IQR 2.8-5) years. Surgeon-entered or patient-reported follow-up was available for 253 (77.8%) patients at 3 years or greater postoperatively. One patient experienced an early small bowel obstruction and was reoperated on within 30 days. Two-hundred forty-five radiographic examinations were available up to 6 years postoperatively. Twenty-seven patients had hernia recurrence on radiographic examination up to 6 years postoperatively. During long-term follow-up, two mesh-related complications required reoperations: mesh removed for chronic pain and mesh removal at the time of colon surgery for perforated cancer. Sixteen additional patients required reoperation within 6 years for the following reasons: hernia recurrence (n = 5), unrelated intraabdominal pathology (n = 9), obstructed port site hernia (n = 1), and adhesive bowel obstruction unrelated to the prosthesis (n = 1). The rate of reoperation due to intraperitoneal mesh complications was 0.62% (2/325) with up to 6 year follow-up.
Conclusion:
Intraperitoneal mesh for repair of small to medium-sized hernias has an extremely low rate of long-term mesh-related complications. It remains a safe and durable option for hernia surgeons.
Insights
Minimally invasive intraperitoneal onlay mesh (IPOM) repair for ventral hernias shows a very low rate of long-term mesh complications. This study confirms IPOM is a safe and durable option for small to medium hernias.
Area of Science:
- Abdominal Surgery
- Hernia Repair
- Minimally Invasive Surgery
Background:
- Intraperitoneal onlay mesh (IPOM) placement for hernias faces scrutiny due to potential long-term complications.
- Limited data exists on long-term outcomes following minimally invasive surgery (MIS) IPOM repairs.
Purpose of the Study:
- To evaluate long-term outcomes and mesh-related complications after MIS IPOM ventral hernia repairs.
- To assess the safety and durability of IPOM for small to medium-sized hernias.
Main Methods:
- Retrospective review of adult patients undergoing MIS IPOM ventral hernia repair (October 2013 - October 2020).
- Outcomes analyzed included hernia recurrence and mesh-related complications or reoperations up to 6 years postoperatively.
Main Results:
- 325 patients were included with a median follow-up of 3.6 years.
- The rate of reoperation due to intraperitoneal mesh complications was 0.62% (2/325) up to 6 years.
- Hernia recurrence was observed in 27 patients on radiographic examination up to 6 years.
Conclusions:
- Intraperitoneal mesh for small to medium hernias demonstrates an extremely low rate of long-term mesh-related complications.
- MIS IPOM remains a safe and durable surgical option for hernia repair.
