The history of the intraperitoneal onlay mesh (IPOM) procedure was first discussed in the early 1990’s. While this procedure was highly controversial in the medical community because of increased risks to patients, it was utilized by some physicians. The Atrium C-Qur and Ethicon Physiomesh were intended to be “tissue separating meshes” for laparoscopic inguinal herniorraphy (LIHR). These products were intended for the IPOM implantation technique for LIHR. IPOM involves placement of mesh directly onto peritoneum overlapping the hernia defect using laparoscopic cannulas. When implanted with the IPOM technique, the mesh has direct contact with intestines, which can lead to serious patient complications. These products were promoted to limit or prevent complications known to be associated with implantation adjacent to the intestines. In reality, these products were never proven to limit or prevent complications.
History of the Intraperitoneal Onlay Mesh Technique
The diagram shows the IPOM implantation position (a), compared to other mesh insertion options. IPOM is the only one where the mesh is in contact with the bowel. IPOM is highly controversial and involved direct contact with bowel. It requires mesh that in theory prevents adhesion, yet achieves abdominal wall ingrowth. The photo on the right shows the placement in surgery. The mesh is in direct contact with the bowel, which causes potential problems for patients.