Laparoscopic IPOM versus open sublay technique for elective incisional hernia repair: a registry-based, propensity score-matched comparison of 9907 patients

Surg Endosc. 2019 Oct;33(10):3361-3369. doi: 10.1007/s00464-018-06629-2. Epub 2019 Jan 2.


Background: For comparison of laparoscopic IPOM versus sublay technique for elective incisional hernia repair, the number of cases included in randomized controlled trials and meta-analyses is limited. Therefore, an urgent need for more comparative data persists.

Methods: In total, 9907 patients with an elective incisional hernia repair and 1-year follow-up were selected from the Herniamed Hernia Registry between September 1, 2009 and June 1, 2016. Using propensity score matching, 3965 (96.5%) matched pairs from 4110 laparoscopic IPOM and 5797 sublay operations were formed for comparison of the techniques.

Results: Comparison of laparoscopic IPOM versus open sublay revealed disadvantages for the sublay operation regarding postoperative surgical complications (3.4% vs. 10.5%; p < 0.001), complication-related reoperations (1.5% vs. 4.7%; p < 0.001), and postoperative general complications (2.5% vs. 3.7%; p = 0.004). The majority of surgical postoperative complications were surgical site infection, seroma, and bleeding. Laparoscopic IPOM had disadvantages in terms of intraoperative complications (2.3% vs. 1.3%; p < 0.001), mainly bleeding, bowel, and other organ injuries. No significant differences in the recurrence and pain rates at 1-year follow-up were observed.

Conclusion: Laparoscopic IPOM was found to have advantages over the open sublay technique regarding the rates of both surgical and general postoperative complications as well as complication-related reoperations, but disadvantages regarding the rate of intraoperative complications.

Keywords: Complications; Hernia registry; Incisional hernia; Laparoscopic IPOM; Sublay.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Elective Surgical Procedures
  • Female
  • Follow-Up Studies
  • Herniorrhaphy / methods*
  • Humans
  • Incisional Hernia / surgery*
  • Intraoperative Complications / epidemiology
  • Laparoscopy*
  • Male
  • Matched-Pair Analysis
  • Middle Aged
  • Pain / epidemiology
  • Postoperative Complications / epidemiology*
  • Propensity Score
  • Registries
  • Reoperation / statistics & numerical data
  • Seroma / epidemiology
  • Surgical Mesh