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Jani. Mini-invasive Surg 2018;2:14 I http://dx.doi.org/10.20517/2574-1225.2018.08 Page 7 of 9

our patients. The reported incidence of seroma in literature is directly proportional to the methods used
to detect its presence, with the highest incidence seen when routine ultrasonography is performed for all
patients . The rate of this event occurring in IPOM plus is reported as 0-11.43% . Its occurrence IPOM plus
[30]
[15]
as compared to standard IPOM surgery is controversial as different studies have reported IPOM plus to have
better outcomes , similar outcomes or worse outcomes as compared to IPOM surgery. Chronic pain, i.e.,
[27]
[31]
[32]
pain perceived at operative site beyond 6 months, was reported by 5 of our patients. While it has been postulated
[15]
that closure of the fascia under tension may lead to higher pain perception by patients , Clapp et al. reported
[27]
similar rates of chronic pain after both IPOM plus and standard IPOM in their series. Two of our patients
had recurrence, of which one patient had undergone an IPOM plus repair for paraumbilical hernia and the
other had undergone an IPOM repair for incisional hernia. Both these patients were re-operated and an
inadequately sized mesh was found to be the culprit, as after shrinkage, it had left the original defect exposed
partially. In both the cases, IPOM plus repair was done laparoscopically. Literature favors IPOM plus with a
lower incidence of recurrences as compared to standard IPOM surgery [32,33] .

Improvement in functional status of abdominal muscles has been reported after an IPOM Plus repair. Both
Den Hartog et al. and Clapp et al. reported improved isokinetic strength of the trunk flexor muscles and
[27]
[34]
better functional activity after closure of the fascial defect. Thus, IPOM plus repair is safe, feasible and with
possible advantages over a standard IPOM repair as reported in literature.

DECLARATIONS
Authors’ contributions
Jani K contributed solely to the paper.

Data source and availability
The data is with the author and is available for scrutiny.

Financial support and sponsorship
None.

Conflicts of interest
There are no conflicts of interest.

Patient consent
Informed consent of all patients was taken for the procedure as well as for non-indentifying inclusion in
academic study.

Ethics approval
The approval of hospital ethics committee was taken for the inclusion of patients' data in the study.

Copyright
© The Author(s) 2018.

REFERENCES
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2. Lewis RT, Wiegand FM. Natural history of vertical abdominal parietal closure: prolene versus Dexon. Can J Surg 1989;32:196-200.
3. Sugerman HJ, Kellum JM Jr, Reines HD, DeMaria EJ, Newsome HH, Lowry JW. Greater risk of incisional hernia with morbidly obese
than steroid-dependent patients and low recurrence with prefascial polypropylene mesh. Am J Surg 1996;171:80-4.
4. Heniford BT, Park A, Ramshaw BJ, Voeller G. Laparoscopic repair of ventral hernias nine years’ experience with 850 consecutive