Laparoscopic IPOM technique

The laparoscopic intraperitoneal onlay mesh (IPOM) technique for the repair of incisional and parastomal hernias has increasingly gained popularity since its first description in 1993. The main advantage in comparison with the open approach is the reduced incidence of wound complications and the recurrence rate also seems to be lower. The laparoscopic technique is based on dissection of the complete abdominal wall. The whole original scar must be covered with a broad overlap of at least 5 cm. Structures like the falciform ligament and the ligamentum teres hepatis must be dissected and the prevesical space must be opened to allow adequate fixation and incorporation of the mesh. Meshes used for laparoscopic approaches must induce strong and rapid incorporation on the parietal side and they should also prevent adhesions on the visceral side. The material should allow an overlap of two or more meshes to treat major defects. Isolated technical details are not supported by high evidence-based clinical data and can only be interpreted as summaries of personal preferences. However with respect of three basic aspects, coverage of the whole original scar, broad overlap of 5 cm and more and the use of adequate mesh material, very good clinical results can be obtained by the laparoscopic IPOM technique.