Comparative Study Between Laparoscopic Transabdominal Preperitoneal Repair Plus and Laparoscopic Intraperitoneal Onlay Repair Plus of Umbilical and Paraumbilical Hernia

Abstract

Laparoscopic ventral hernia repair has evolved to minimize the morbidity and recurrence rates associated with traditional open repairs. As laparoscopic expertise grows and newer mesh materials are developed, these techniques have become increasingly accepted due to the advantages of minimally invasive surgery. In laparoscopic hernia repair, mesh placement can either be intraperitoneal or preperitoneal. Intraperitoneal Onlay Mesh (IPOM+) placement brings the mesh into direct contact withabdominal contents, potentially leading to complications such as chronic pain, intestinal obstruction, fistula formation, infertility, and adhesions. To counteract these issues, composite meshes combining polypropylene with inert substances like collagen or cellulose have been introduced, though their high cost remains a challenge. An alternative approach, Transabdominal Preperitoneal (TAPP+) repair, uses a less expensive polypropylene mesh placed in the preperitoneal space, minimizing adhesion formation and mesh-related complications. However, the TAPP+ procedure is technically more demanding and can result in longer operative times. This study compares the safety and efficacy of TAPP+ and IPOM+ techniques in repairing umbilical and paraumbilical hernias, with emphasis on economical aspects.

Keywords: IPOM+; TAPP+; laparoscopic; paraumbilical hernia; umbilical hernia.

FIGURE 1

Hernial sac with content.

FIGURE 2

Hernial content reduced.

FIGURE 3

Defect closure using barbed suture.

FIGURE 4

Mesh placed inside pre peritoneal space.

FIGURE 5

Adhesiolysis.

FIGURE 6

Hernial defect with sac.

FIGURE 7

Defect closure using barbed sutures.

FIGURE 8

Composite mesh fixation using tackers.