Outcomes of intraperitoneal compared to retromuscular mesh placement in ventral incisional hernia repair: a systematic review and meta-analysis.

James Burns, Mauricio Sarmiento Cobos, Sameh Hany Emile, Samuel Szomstein, Ana Pena, Amir Bashiri, Emanuele Lo Menzo

Abstract readSystematic ReviewMeta-AnalysisComparative Study

In one paragraph

Synthesis in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

Authors and funding

7 authors.

James BurnsCharles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA.

Mauricio Sarmiento CobosDepartment of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL, USA.

Sameh Hany EmileEllen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.

Samuel SzomsteinDepartment of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL, USA.

Ana PenaDepartment of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL, USA.

Amir BashiriCharles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA.

Emanuele Lo MenzoDepartment of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL, USA. lomenze@ccf.org.ORCID http://orcid.org/0000-0001-8385-9002

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionThe ideal position of mesh in ventral hernia repair remains controversial. Intraperitoneal onlay mesh (IPOM) and retromuscular mesh (RM) placements are two widely used techniques, each with distinct anatomical and technical considerations. While it is well established that mesh reinforcement reduces hernia recurrence compared to suture repair, outcomes may vary according to the mesh location. This systematic review aimed to assess the recurrence and postoperative complications between IPOM and RM placement in ventral incisional hernia repair (VIHR). METHODS AND PROCEDURES: This systematic review was reported in compliance with the PRISMA 2020 guideline. PubMed, Scopus, and Cochrane were searched for observational and randomized studies reporting outcomes of RM and IPOM in ventral incisional hernia repairs. The primary outcome was hernia recurrence. Secondary outcomes included total postoperative complications, major complications, intraoperative complications, operating time, readmissions, and hospital length of stay (LOS).

resultsSeven studies, including six retrospective analyses and one RCT, comprised 916 patients, of whom 352 (38.4%) underwent IPOM, and 564 (61.6%) underwent RM placement. Most IPOM repairs were performed laparoscopically, while RM repairs were primarily open. The odds of recurrence were significantly lower when RM was used compared to IPOM (OR 0.34, 95%CI 0.15, 0.77, p = 0.009, I

conclusionsRM placement may be associated with lower hernia recurrence than IPOM, with a similar likelihood of complications. These findings should be cautiously interpreted because of the low certainty, heterogeneous evidence, and the use of different recurrence and major-complication definitions across studies.

Indexed as

Hernia, VentralHerniorrhaphyIncisional HerniaSurgical MeshHumansLaparoscopyLength of StayOperative TimePostoperative ComplicationsRecurrenceTreatment OutcomeIncisional herniaLaparoscopyOpenRetromusclar mesh repairVentral hernia

Identifiers

PMID42533165

DOI10.1007/s00464-026-13218-1

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