The main difference is simple: in IPOM the defect may remain open beneath the mesh; in IPOM Plus it is closed first.
Indications
IPOM and IPOM Plus may be used in some cases of:
- Emergency surgery in overweight or obese patients
How IPOM is performed
- ILaparoscopic access
The abdominal cavity is entered through small laparoscopic access sites.
- IIAdhesiolysis and hernia reduction
The peritoneal adhesions are freed and the hernia contents are returned to the abdomen.
Laparoscopic view of the defect. - IIIDefect suture — IPOM Plus only
The wall defect is sutured only in IPOM Plus. In traditional IPOM, by contrast, the defect may be left unsutured beneath the mesh.
- IVMesh placement and fixation
A mesh is placed to close the defect and secured with fixation devices: tackers, glue or sutures.
Intraperitoneal mesh covering the defect. 
Tacker used to fix the mesh.
IPOM Plus: why close the defect first?
In IPOM Plus the defect is sutured first. This makes it possible to:
- 01better restore the continuity of the wall
- 02reduce residual bulging
- 03improve the profile of the midline
- 04distribute tension differently
The main limitation: the intraperitoneal position of the mesh
The main feature that distinguishes IPOM and IPOM Plus from extraperitoneal techniques is the position of the mesh (meshes that are nonetheless designed to be in contact with the bowel).
Risks of an intraperitoneal mesh
- 01adhesions between the viscera and the mesh
- 02adhesions between the viscera and the fixation devices
For this reason, when technically possible, reconstructions that keep the mesh outside the abdominal cavity are now often preferred, for example:
Mesh outside the abdominal cavity
- 01Retromuscularbehind the rectus muscles, in front of the posterior fascia
- 02Preperitonealbetween the posterior fascia and the peritoneum
- 03Extraperitonealoutside the peritoneum, without entering the abdomen
It is not only important to close the defect: it is also important to choose the plane in which the mesh is left.
Laparoscopy and robotics
IPOM was born as a laparoscopic technique. Robotics may be used in some settings, especially when a more complex wall reconstruction is combined.
Learn moreRobotic abdominal wall surgeryTiming and hospital stay
- About 1h30
Duration of surgery
- 1–2 days
Hospital stay
Post-operative recovery
immediate
- QuicklyReturn to daily life
- GraduallyReturn to exertion and sport
IPOM and modern extraperitoneal techniques
Advances in minimally invasive surgery have made many alternatives available that avoid placing the mesh inside the peritoneal cavity, including:
The choice depends on the type of defect, the surgical history and whether more favourable anatomical planes can be used.
Frequently asked questions
What is the difference between IPOM and IPOM Plus?
In IPOM Plus the wall defect is sutured before the mesh is placed; in traditional IPOM the defect may not be closed.
Is the mesh inside the abdominal cavity?
Yes. This is precisely the feature that defines IPOM.
Can the mesh be in contact with the bowel?
The mesh used for IPOM must be designed for intraperitoneal use, but when possible it may be preferable to use planes that separate the mesh from the viscera.
Are there alternatives to IPOM?
Yes. Today there are many retromuscular and preperitoneal techniques that keep the mesh outside the abdominal cavity.
Mesh position is part of the surgical choice
IPOM and IPOM Plus are valid techniques in selected patients, but abdominal wall surgery today also offers many extraperitoneal alternatives. The strategy is chosen by assessing the defect, anatomy, previous surgery and the most suitable plane for the mesh.