IPOM for the treatment of ventral and incisional hernias

In the field of ventral and incisional hernia surgery, there is much discussion about the optimal technique for placement of mesh implants. In addition to other surgical techniques, the surgical discourse is currently focused on the intraperitoneal onlay mesh technique (IPOM) and the open sublay technique.

A recent Herniamed registry study with almost 10,000 surgical patients has now highlighted the advantages and disadvantages of the laparoscopic IPOM and open sublay techniques. The IPOM technique performed less well in terms of intraoperative complications (2.3% vs. 1.3% for bleeding and organ injuries). However, patients in the IPOM group experienced significantly fewer postoperative complications, such as wound infections and secondary bleeding (3.4% vs. 10.5%), and only 1.5% of the patients required complication-related surgical revision (sublay: 4.7%). The average hospital stay for the IPOM technique (4 ± 3 days) was considerably shorter than for the sublay technique (6 ± 5 days). RecurrenceIn medicine, recurrence refers to the return of a disease after previous treatment. This is also known as relapse. rates and pain intensity were comparable 1 year after the procedure.¹

More than 15 years ago, pfmmedical succeeded in developing a technique for applying an extremely thin layer of titanium in the nanometer range to polypropylene and covalently bonding it. This technique is unique in the world. It means that the flexibility of the base material remains intact and is combined with the good bio compatibility of titanium.

For the minimally invasive IPOM method, TiMESH titanised polypropylene meshes offer a range of advantages, especially with regard to the body compatibility.

The titanisation makes the normally hydrophobic polypropylene hydrophilic. This plays an essential role in the excellent biocompatibility of TiMESH². Thanks to the titanisation, there is a less pronounced activation of the immune system^2,6.

Furthermore, following its insertion, the hydrophilic surface of TiMESH leads to a quick colonisation by the body's own fibroblasts and hence, neoperitonealisation of the mesh⁴.

According to the guidelines of the IEHS (International Endohernia Society), TiMESH is suitable for IPOM application and all surgical techniques in the field of hernia surgery⁵. pfmmedical titanised meshes are available in various sizes and weights, and allow for case-by-case selection depending on the procedure and the patient.

pfmmedical titanised mesh implants are all suitable for IPOM. We even talk of Easy IPOM. Since the meshes are coated on both sides, no additional adhesion prophylaxisProphylaxis (Greek for prevention) encompasses all measures designed to prevent a disorder. is required for the application and there is no risk of confusing the peritoneal and visceral sides of the mesh.

Other advantages are:

• No preparation (e.g. moistening) of the mesh implant is required
• Smooth trocar insertion
• All fixation systems can be used
• Very good peritoneal ingrowth

1. Köckerling, F., Simon, T., Adolf, D. et al. Laparoscopic IPOM versus open sublay technique for elective incisional hernia repair: a registry-based, propensity score-matched comparison of 9907 patients. Surg Endosc 33, 3361–3369 (2019).
2. Scheidbach H., Tamme C., Tannapfel A., Lippert H., Köckerling F., In vivo studies comparing the biocompatibility of various polypropylene meshes and their handling properties during endoscopic total extraperitoneal (TEP) patchplasty: an experimental study in pigs. Surg Endosc., 2004. 18(2): p. 211-220.
3. Binnebösel M., Junge. K., Klink C. D., Serno J., Otto J., Conze J., Öttinger A. P., Schumpelick V., Adhesion as a Chronic Inflammatory Problem? Risk for Adhesions, Migration, and Erosions?, in Hernia Repair Sequelae, S. V. and F.R. J., Editors. Springer-Verlag Berlin Heidelberg 2010, 305-315.
4. Lehle K., Lohn S. Verbesserung des Langzeitverhaltens von Implantaten und anderen Biomaterialien auf Kunststoffbasis durch plasmaaktivierte Gasphasenabscheidung (PACVD), Abschlussbericht Forschungsverbund “Biomaterialien (FORBIOMAT II)”, 149–173, 2002
5. Bittner, R., Bingener-Casey, J., Dietz, U. et al., Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society [IEHS]) - Part III. Surg Endosc 2014, 28:380–404.
6. Schug-Paß C., Tamme C., Tannapfel A., Köckerling F., A lightweight polypropylene mesh (TiMesh) for laparoscopic intraperitoneal repair of abdominal wall hernias: : comparison of biocompatibility with the DualMesh in an experimental study using the porcine model., Surg Endosc. 2006, 20(3): 402-409.