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

Authors

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

Published in

Surgical endoscopy. Jul 30, 2026. Epub Jul 30, 2026.

Abstract

The 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).
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).
Seven 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, I² = 0%).There were no significant differences between the two mesh placement locations in total complications (OR 0.95, 95%CI 0.44, 2.04, p = 0.885) or major complications (OR: 1.58, 95%CI 0.37, 6.70, p = 0.533). Both techniques had similar odds of SSIs, seromas, hematomas, and wound dehiscence. Additionally, there were no significant differences in intraoperative complications, operative time, or readmission.
RM 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.

PMID:
42533165
Bibliographic data and abstract were imported from PubMed on 31 Jul 2026.

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