Introduction In intraperitoneal-onlay-mesh repair with hernia defect closure (IPOM-plus), the abdominal cavity can be reliably approached through the hernial orifice. Adhesions can then be detached, and the hernial orifice can be closed by direct visual manipulation. Presentation of cases IPOM-plus via the hernial orifice approach was performed in 49 patients. First, an incision is made just above the hernial orifice to reach the abdominal cavity. Under direct visualization, the adhesions are dissected, and the mesh is inserted after laparoscopic manipulation. After closing the hernial orifice under direct visual manipulation, the mesh is fixed again under laparoscopic guidance. Conclusions This technique has the advantages of an easy intra-abdominal approach and direct visual manipulation. No mesh infections were observed in this study, suggesting that it may be useful as a hybrid procedure.
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