Chelala Elie, Jacob Brian
Belgian Section of Abdominal Wall Surgery Chirec/Delta-Hospital, Departement of Digestive & Bariatric Surgery, Brussels, Belgium.
International Hernia Collaboration, Icahn School of Medicine at Mount Sinai, NYC Partner, Laparoscopic Surgical Center of New York, New York, NY, United States.
J Abdom Wall Surg. 2025 Jun 18;4:14459. doi: 10.3389/jaws.2025.14459. eCollection 2025.
The current Intraperitoneal Underlay Mesh (IPUM), previously referred to as IPOM (onlay), initially faced several challenges due to design and methodological shortcomings, particularly with the use of a bridging technique without defect closure. These limitations contributed to elevated recurrence rates, mesh bulging, seroma formation, and suboptimal abdominal wall function. Although complications such as adhesions, bowel erosion, fistula formation, and mesh migration were rare, they were mostly associated with non-composite or poorly designed meshes and inadequate fixation. These concerns led to growing skepticism regarding intraperitoneal mesh placement and a shift in preference toward retrorectus mesh positioning. Since 2007, the evolution of IPUM+ techniques-where the "+" denotes primary defect closure combined with the use of advanced composite meshes, has led to significantly improved outcomes. Long-term studies, meta-analyses, and randomized trials have demonstrated better functional results, reduced complications, and broader acceptance among surgeons and patients. These advancements have positioned IPUM+ as a reliable and effective option, especially when long-term outcomes of alternative techniques such as eTEP, ventral TAPP, or robotic approaches remain under long term follow up evaluation. IPUM+ continues to serve as a valuable technique for small to moderate or recurrent ventral hernias when performed by experienced surgeons. Future directions should aim to define its role in personalized hernia care, integrating hybrid methods and emerging technologies for complex repairs.
当前的腹膜内补片下层修补术（IPUM），以前称为腹膜前补片修补术（IPOM，补片置于腹壁上），最初由于设计和方法上的缺陷面临一些挑战，特别是在使用桥接技术而未关闭缺损时。这些局限性导致复发率升高、补片膨出、血清肿形成以及腹壁功能欠佳。虽然粘连、肠侵蚀、瘘管形成和补片移位等并发症很少见，但大多与非复合补片或设计不佳的补片以及固定不充分有关。这些问题导致人们对腹膜内补片放置的怀疑日益增加，并且更倾向于采用腹直肌后补片放置。自2007年以来，IPUM+技术的发展——其中“+”表示原发性缺损关闭并结合使用先进的复合补片，已带来显著改善的结果。长期研究、荟萃分析和随机试验表明，其功能效果更好、并发症减少，并且在外科医生和患者中得到更广泛的接受。这些进展使IPUM+成为一种可靠且有效的选择，尤其是当诸如完全腹膜外腹腔镜疝修补术（eTEP）、经腹腹膜前腹腔镜疝修补术（ventral TAPP）或机器人手术等替代技术的长期结果仍在长期随访评估中时。当由经验丰富的外科医生进行操作时，IPUM+对于中小或复发性腹疝仍然是一种有价值的技术。未来的方向应旨在确定其在个性化疝治疗中的作用，整合混合方法和新兴技术用于复杂修补。
