Abstract: Comparative Review of SIL-TES and IPOM Ventral Hernia Mesh Repair

A retrospective multi-center study compares clinical outcomes between single-incision laparoscopic totally extra-peritoneal sub-lay (SIL-TES) mesh repair and laparoscopic intraperitoneal onlay mesh (IPOM) repair for ventral hernia (VH). A total of 104 patients were enrolled across five hernia centers, including 50 patients receiving SIL-TES repair and 54 patients undergoing conventional IPOM repair. The SIL-TES technique leverages professional single-access devices such as LAGIS and Senscure. The single-incision length can be limited to 2.0–2.5 cm, lowering trocar-site hernia risks and delivering superior cosmetic results.

The typical incision layout in SIL-TES for defects in different regions.

a: M1; b: M2; c: M3; d: f M4–M5; g L2 and/or L3; h L4; gray shadow: Camera scope direction; red dot: Incision site; blue area: defect site; region L, M is based on the incisional hernia classification of EHS.

For SIL-TES procedures, a port-site incision is planned according to hernia defect location. The retro-muscular space is dissected under laparoscopic vision, followed by exposure and protection of the neurovascular bundle. After hernia sac management, a lightweight 15 cm ×15 cm polypropylene mesh is placed in the retro-rectus space with at least 5 cm overlap beyond the defect margin. Mesh fixation with tacks is unnecessary for many patients. Drainage placement is optional, depending on hernia type.

SIL-TES procedure.

Separate in retro-rectus space (a) and Retzius space (b). c Expose and protect the neurovascular bundle. d Incise the medial aspect of the posterior rectus sheath. e linea alba hernia. f and g Incise the hernia sac. h Incise the lateral aspect of the posterior rectus sheath. Close posterior rectus sheath (i) and peritoneal laceration (j). Close hernia defect by continuous reverse sewing (k) or by intermittent trans-fascial sutures (l). Place the mesh (m) and drainage (n).

The IPOM group adopted standard multi-port laparoscopic intraperitoneal mesh repair. After pneumoperitoneum establishment, three main trocars plus additional contralateral trocars were placed for adhesiolysis, defect closure and mesh positioning. Mesh was fixed circumferentially with absorbable tacks and transabdominal sutures. Extensive adhesiolysis often required drain placement.

Perioperative data demonstrated distinct differences between the two groups. The SIL-TES group achieved a significantly lower drainage placement rate (20% vs 61%). Mean hospital length of stay was only 4.3 ±0.4 days in the SIL-TES cohort, compared with 8.3 ±0.3 days for IPOM patients. Total hospitalization cost was also substantially reduced in SIL-TES patients ($2937.3 ±58.3 vs $7126.9 ±141.4). No intraoperative bowel injury occurred in SIL-TES, while two bowel injuries were recorded in the IPOM group.

Postoperative pain and movement limitation scores, assessed via VAS and Carolina Comfort Scale (CCS) at 1 and 3 months, were markedly lower for SIL-TES patients. No hernia recurrence or readmission was observed over a 12-month mean follow-up period.

SIL-TES combines the strengths of single-incision laparoscopic surgery (SILS) and totally extra-peritoneal sub-lay (TES) techniques. By eliminating multi-channel puncture, it reduces abdominal wall trauma and postoperative pain. This combined approach proves safe, cost-effective and delivers favorable cosmetic and quality-of-life outcomes, serving as a promising minimally invasive alternative for selected ventral hernia patients.

Source: single-incision laparoscopic total extra-peritoneal sub-lay (SIL-TES) mesh repair versus laparoscopic intraperitoneal onlay mesh (IPOM) repair for ventral hernia

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