Laparoscopic Intraperitoneal Onlay Mesh Repair for Non-Midline Incisional Hernias: A Single-Center Clinical Study

Abstract

Purpose:

Non-midline incisional hernias are technically challenging abdominal wall defects, and evidence of laparoscopic intraperitoneal onlay mesh (IPOM) in this setting is limited. This study evaluated the safety and efficacy of laparoscopic IPOM for non-midline incisional hernias and assessed the impact of different defect closure techniques on perioperative outcomes.

Methods:

This single-center retrospective study included patients who underwent laparoscopic IPOM repair for non-midline incisional hernias between September 2019 and June 2025. Demographics, body mass index, comorbidities, hernia classification, defect size and area, closure technique, operative time, blood loss, postoperative length of stay, 24-hour pain scores, complications, and recurrence were recorded. Comparisons among the closure groups were performed using the Kruskal–Wallis test.

Results:

A total of 43 patients were included. The mean defect area was 57.15 ± 53.12 cm², operative time was 133.51 ± 40.68 minutes, intraoperative blood loss was 20.65 ± 11.42 mL, and postoperative hospital stay was 5.79 ± 2.45 days. Overall complication rate was 7.0%, including 1 case each of chronic pain, seroma, and ileus, and recurrence occurred in 1 patient. Barbed suture, hernia needle, and combined closure techniques were used in 10, 16, and 17 patients, respectively. The combined group had larger defects and longer operative times, whereas blood loss, hospital stay, and 24-hour pain scores were comparable among the groups.

Conclusions:

Laparoscopic IPOM is a safe and effective option for non-midline incisional hernias, achieving low complication and recurrence rates. A combined closure technique is suitable for larger defects, increasing operative time without worsening early perioperative outcomes.