A review of literature and new comprehensive classification of “Mesh Repair Methods” (MRM classification) for abdominal wall hernias
DOI:
https://doi.org/10.18203/2349-2902.isj20261196Keywords:
Hernia mesh implantation, Abdominal muscle planes, Double mesh and sandwich repairAbstract
The use of prosthetic mesh has brought a revolution in the history of the repair of abdominal wall hernia. Evidences suggest that using mesh for hernia repair significantly reduces recurrence. Every plane of abdominal musculature has been explored for mesh implantation. Various names have been used to describe each plane and different methods of implantation. But the terminologies used for various practices of mesh implantation are ambiguous and confusing. Inconsistent and confusing terminologies leads to difficulty in comparing and analyzing the literature. The aim of this review is to group various practices by identifying the basic method of utilizing various planes of abdominal wall musculature and bring them under some self-explanatory terminologies. Hernia-mesh implantation methods related articles were searched using Medline, PubMed and the Cochrane library during October 2024 to March 2025. 90 articles were shortlisted for this study. In our review of various available articles, we focused on identifying: abdominal plane utilized, number of planes utilized, number of sheets of mesh implanted, details of mode of implantation (open, endoscopic or hybrid), terminologies used for the planes, and overall name given for that concept. We tried to group various methods of mesh implantation according to above findings. This new comprehensive classification of “mesh repair methods” (MRM classification) is intended to be self-explanatory and its adoption would avoid ambiguity and improve comparison and communications for research studies of various practices of hernia mesh implantation.
Metrics
References
Sosin M, Nahabedian MY, Bhanot P. The perfect plane: a systematic review of mesh location and outcomes, update 2018. Plast Reconstr Surg. 2018;142:S107-16. DOI: https://doi.org/10.1097/PRS.0000000000004864
Parker SG, Halligan S, Liang MK, Muysoms FE, Adrales GL, Boutall A, et al. International classification of abdominal wall planes (ICAP) to describe mesh insertion for ventral hernia repair. BJS. 2020;107:209-17. DOI: https://doi.org/10.1002/bjs.11400
Felix EL, Michas C. Double-buttress Laparoscopic herniorrhaphy. Jr of Laparoendoscopic Surg. 1993;3(1):1-8. DOI: https://doi.org/10.1089/lps.1993.3.1
Weber-Sanchez A, Weber-Alvarez, Martinez, DG, Leon AS. Double mesh in special cases of Laparoscopic inguinal hernia repairs: case series study. MOJ Surg. 2023;11(3):166-9. DOI: https://doi.org/10.15406/mojs.2023.11.00247
Wada T, Kawada K, Hasegawa S, Sakai Y. Laparoscopic repair of recurrent parastomal hernias of an end stoma using the sandwich technique while preserving ileal conduit: A case report. Int J Surg Case Rep. 2016;25:75-8. DOI: https://doi.org/10.1016/j.ijscr.2016.06.007
Tatay FC, Pastor PG, Liedo JB, Ortiz MS, Diana SB, Hernandez JI, et al. Subxyphoid incisional hernia treatment: a technique using a double mesh adjusted to the defect. Cir Esp. 2011;89(6):370-8. DOI: https://doi.org/10.1016/S2173-5077(11)70046-1
Zanellato A, Coke E, Goudie S, Patton S. Double-mesh for management of Full thickness abdominal wall defects following tumour resection. Can further sequels be avoided. BJS. 2024;3(5):znae122.478. DOI: https://doi.org/10.1093/bjs/znae122.478
Moreno Egea A, Aguayo-Albasini JL. Historic analysis of complex incisional hernia: to an understanding of the double prosthetic repair technique. (Spanish). Cir Esp. 2010;88(5):292-8. DOI: https://doi.org/10.1016/S2173-5077(10)70034-X
Topcu R, Sezikli J, Topcu H. Bilayer repair tchnique with mesh in Petit lumbar hernia. Anatolian Curr Med J. 2021;3(4):310-4. DOI: https://doi.org/10.38053/acmj.978511
Kockerling F, Scheuerlein H, Schug-Pass C. Treatment of large incisional hernias in sandwich technique- A review of the literature. Front Surg. 2018;5(37):1-9. DOI: https://doi.org/10.3389/fsurg.2018.00037
Parikh APK, Parikh P, Vadodariya D, Dave JP, Bhatt JG. Triple mesh technique in repair of recurrent Lumbar Incisional Hernia. A case report. Int J Res Med Sci. 2019;7(12):4803-6. DOI: https://doi.org/10.18203/2320-6012.ijrms20195560
Gilbert AI, Graham MF, Voigt WJ. A bilayer patch device for inguinal hernia repair. Hernia. 1999;3:161-6. DOI: https://doi.org/10.1007/BF01195319
Guttadauro A, Maternini M, Frassoini S, Simone M, Chiarelli M, Macchini D, et al. “All-in-one mesh hernioplasty: A new procedure for primary inguinal open repair. Asian J Surg. 2018;41(5):473-9. DOI: https://doi.org/10.1016/j.asjsur.2017.07.003
Amid PK, Friis E, Horeyseck G, Kux M. Tension-free Onlay mesh hernioplasty. Operative techniques in General Surgery. 1999;1(2):156-68. DOI: https://doi.org/10.1016/S1524-153X(99)80018-9
LeBlane KA, Booth WV. Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: Preliminary finding. Surg Laparosc Endosc. 1993;3(1):39-41.
Chevrel JP. Traitement des grandes eventrations medianes par plastie en paletot et prosthese. (The traetment of large midline incisional hernias by “overcoat” plasty and prosthesis. Nouv Presse Med. 1979;8:695-6.
Miyake Y, Watanabe G. Mesh repair under the anterior lamina of the rectus sheeth (MUAR) for abdominal incisional hernia. Surg Today. 2021;51(10):1649-54. DOI: https://doi.org/10.1007/s00595-021-02282-w
Butterfield JH, Reparaz LB, Prest PJ. Ostomy closure with prophylactic Anterectus Mesh Placement: An underappreciated, but valuable tissue plane in Hernia Surgery. Am Surg. 2023;89(12):6378-80. DOI: https://doi.org/10.1177/00031348231192045
Kockerling F, Botsinis MD, Rohde C, Reinpold W. Endoscopic-assisted linea alba reconstruction plus mesh augmentaton for treatment of Umbilical and/ or Epigastric hernia and rectus abdominis diastasis. Front Surg. 2016;13(3):27. DOI: https://doi.org/10.3389/fsurg.2016.00027
Claus CM, Malcher F, Cavazzola LT, Furtado M, Morrell A, Azevedo M, et al. Subcutaneous onlay laparoscopic approach (SCOLA) for ventral hernia and rectus abdomonis diastasis repair. A technical description and initial results. Arq Bras Cir Dig. 2018;31(4):e1399. DOI: https://doi.org/10.1590/0102-672020180001e1399
Muas DMJ. Pre-aponeurotic endoscopic repair (REPA) of diastasis recti associated or not to midline hernias. Surg Endosc. 2019;33:1777-82. DOI: https://doi.org/10.1007/s00464-018-6450-3
Luque JB, Luque AB, Gomez AT, Morales-conde S. Totally endoscopic suprapubic approach to ventral hernia repair: Advantages of a new minimally invasive procedure. Cir Esp. 2020;98(2):92-5. DOI: https://doi.org/10.1016/j.cireng.2020.01.008
Gandhi J, Shinde P, Kothari B, Churiwala JJ, Banker A. Endoscopic pre-apponeurotic repair (EPAR) technique with meshplasty for treatment of ventral hernia and Rectus abdominis Diastasis. Indian J Surg 2024;86(2):339-43. DOI: https://doi.org/10.1007/s12262-020-02189-9
Makam R, Chamany T, Nagur B, Bilchod SS, Kulkarni A. Laparoscopic subcutaneous onlay mesh repair for ventral hernia: Our early experience. J Min Access Surg. 2023;19:223-6. DOI: https://doi.org/10.4103/jmas.jmas_225_22
Holihan JL, Nguyen DH, Nguyen MT, Mo J, Kao LS, Liang MK. Mesh location in open ventral hernia repair: a systemic review and network meta-analysis. World J Surg 2016;40(1):89-99. DOI: https://doi.org/10.1007/s00268-015-3252-9
Rives J, Lardennois B, Pire JC, Hibon J. Large incisional hernia. The importance of flail abdomen and of subsequent respiratory disorders. Chirurgie. 1973;99(08):547-63.
Reinpold W. Neue techniken in der Narbenund Bauchwandhernienchirugie. Chirugische Allgeneine. 2013;14:331-7.
Schwarz J, Reinpold W, Bittner R. Endoscopic mini/less open sublay technique (EMILOS)- a new technique for ventral hernia repair. Langenbecks Arch Surg. 2017;402:173-80. DOI: https://doi.org/10.1007/s00423-016-1522-0
Carrara A, Laura E, Fabris L, Frisini M, Rizzo S. Endo-laparoscopic reconstruction of abdominal wall midline with linear stapler, the THT technique. Early results of first case series. Ann Med Sur. 2019;38:1-7. DOI: https://doi.org/10.1016/j.amsu.2018.12.002
Fiori F, Ferrara F, Gentile D, Gobatti D, Stella M. Totally endoscopic sublay anterior repair for ventral & incisional hernias. J Laparoendosc Adv Surg Tech. 2019;21(5):1-7. DOI: https://doi.org/10.1089/lap.2018.0807
Belyansky I, Daes J, Radu VG, Balasubramanian R, Zahiri HR. A novel approach using the enhanced-view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair. Surg Endosc. 2018;32:1525-32. DOI: https://doi.org/10.1007/s00464-017-5840-2
Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ. Transversus abdominis muscle release: A novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg. 2012;204:709-16. DOI: https://doi.org/10.1016/j.amjsurg.2012.02.008
Shenoy KG, Thomas M, Ramesh BS, Jeur AS, Jan N. Novel laparoscopic “lateral -port technique’ of extended totally extraperitoneal approach for ventral hernias.: Short-term results and technical aspect of 100 consecutive cases from a single center. Int J Abdom Wall Hernia Surg. 2024;7:113-23. DOI: https://doi.org/10.4103/ijawhs.ijawhs_15_24
Li B, Gong D, Miao J, Nie X, Qin C. Totally endoscopic sublay repair (TES)-- a novel approach to repair midline ventral hernia. Zhonghua Yi Xue Za Zhi. 2018;98(36):2933-6.
Muysoms F, Van Clevan S, Pletnickx P, Ballecer C, Ramaswamy A. Robotic transabdominal retromuscular umbilical prosthetic hernia repair (TARUP): observational study on the operative time during the learning curve. Hernia. 2018;22:1101-11. DOI: https://doi.org/10.1007/s10029-018-1825-x
Masurkar AA. Laparoscopic trans-abdominal retromuscular (TARM) repair for ventral hernia: A novel, low-cost technique for sublay and posterior component separation. World J Surg. 2020;44(4):1081-5. DOI: https://doi.org/10.1007/s00268-019-05298-z
Stoppa R, Petit J. Abourachid H. Original procedure of groin hernia repair: interposition without fixation of Dacron tulle prosthesis by subperitoneal midline approach. Chirurgie. 1973;99(02):119-23.
Nyhus LM. Ileopubic tract repair of inguinal and femoral hernia: the posterior (preperitoneal) approach. Surg Clin North Am. 1993;73(3):487-99. DOI: https://doi.org/10.1016/S0039-6109(16)46032-9
Ugahary F, Simmermacher RKJ. Groin hernia repair via a grid-iron incision: an alternative technique for preperitoneal mesh insertion. Hernia. 1998;2:123-51. DOI: https://doi.org/10.1007/BF01250028
Kugel RD. Minimally invasive, Non laparoscopic, preperitoneal and sutureless inguinal herniorrhaphy. Am J Surg. 1999;178(4):298-302. DOI: https://doi.org/10.1016/S0002-9610(99)00181-6
Lange JFM, Lange MM, Voropai DA, Van Tilburg MW, Pierie JP, Ploeg RJ, et al. TransRectus Sheath Extraperitoneal Procedure (TREPP) for inguinal hernias: the first 1000 patients. World J Surg. 2014;38(8):1922-8. DOI: https://doi.org/10.1007/s00268-014-2475-5
Pelissier EP. Inguinal hernia: preperitoneal placement of memory-patch ring by anterior approach. Preliminary experience. Hernia. 2006;10:248-52. DOI: https://doi.org/10.1007/s10029-006-0079-1
Lourenco A, da Costa RS. The ONSTEP inguinal hernia repair technique: initial clinical experience of 693 patients in two institutions. Hernia. 2018;17:357-64. DOI: https://doi.org/10.1007/s10029-013-1057-z
McKernan JB, Law HL. Laparoscopic repair of inguinal hernias using a totally extraperitoneal prosthetic approach. Surg Endosc. 1993;7(1):26-8. DOI: https://doi.org/10.1007/BF00591232
Daes J. The enhanced video-totally extraperitoneal technique for repair of inguinal hernia. Surg Endosc Other Interv Tech. 2012;26:1187-9. DOI: https://doi.org/10.1007/s00464-011-1993-6
Arregui ME, Davis CJ, Yucel O. Laparoscopic mesh repair of inguinal hernias using a preperitoneal approach: a preliminary report. Surg Laparosc Endosc. 1992;2(1):53-8.
Kohler G, Lechner M, Kattenbock R, Pfandner R, Harting N. Preperitoneal Umbilical hernia mesh plasty (PUMP): Indication, technique and results. Zentaralbl Chir. 2020;145(1):64-71. DOI: https://doi.org/10.1055/a-0972-1792
Li B, Qin C, Bittner R. Endoscopic totally extraperitoneal approach (TEA) technique for primary ventral hernia repair. Surg Endosc. 2020;34(8):3734-41. DOI: https://doi.org/10.1007/s00464-020-07575-8
Li B, Qin C, Liu D, Miao J, Yu J, Bittner R. Subxiphoid top-down endoscopic totally preperitoneal approach (eTPA) for midline ventral hernia repair. Langenbecks Arch Surg. 2021;406:2125-32. DOI: https://doi.org/10.1007/s00423-021-02259-w
Alpuche HAV, Torres FR, Gonzalez JPS. Early results of eTEP access surgery with preperitoneal repair of primary midline ventral hernias and diastasis recti. A 33 patients case series of “PeTEP”. Surg Endosc. 2024;38:3204-11. DOI: https://doi.org/10.1007/s00464-024-10832-9
Gangakhedkar S, Francis G, Holmes M, Wright T. Laparoscopic repair for a recurrent epigastric incisional hernia following xiphoidectomy: a case report. J Case Rep Images Surg. 2024;10(1):48-51. DOI: https://doi.org/10.5348/100138Z12SG2024CR
Sikar HE, Cetin K, Eyvaz K, Kaptanoglu L, Kucuk HF. Laparoscopic repair of large suprapubic hernias. Wideochir Inne tech Maloinwazyjne. 2017:12(3):245-50. DOI: https://doi.org/10.5114/wiitm.2017.68794
Palanivelu C, Vijaykumar M, Jani KV, Rayan PS, Maheshkumaar GS, Rajapandian S. Laparoscopic transabdominal preperitoneal repair of spigelian hernia. JSLS. 2006;10:193-8.
Huang DY, Pan L, Chen MY, Fang J. Laparoscopic repair via the transabdominal preperitoneal procedure for bilateral lumber hernia: Three-cases report and review of literature. World J Clin Cases. 2018;6(10):398-405. DOI: https://doi.org/10.12998/wjcc.v6.i10.398
Sun J, Chen X, Li J, Dong F, Zheng M. Transabdominal partial extraperitoneal (TAPE) technique in laparoscopic lumbar hernia repair. BMC Surg. 2015;15:118-22. DOI: https://doi.org/10.1186/s12893-015-0104-3
Sharma A, Dey A, Khullar R. Laparoscopic repair of suprapubic hernia: transabdominal partial extraperitoneal (TAPE) technique. Surg Endosc. 2011;25:2147-52. DOI: https://doi.org/10.1007/s00464-010-1513-0
Li H, Cheng Z, Yan W, Hu X, Wang J. Retroperitoneal totally endoscopic prosthetic repair of lumbar hernia. Sci Rep. 2023;13:20736. DOI: https://doi.org/10.1038/s41598-023-48226-x
Rajwade BK, Patel RV, Jain YD, Bhoge RP, Sharma PP. Ventral hernia repair using Ventralex R ST Patch: A single-center study of clinical outcomes and complications. Cureus. 2022;14(9):e29341. DOI: https://doi.org/10.7759/cureus.29341
Kockerling F, Lammers B. Open Intraperitoneal Onlay Mesh (IPOM) Technique for Incisional Hernia Repair. Front Surg. 2018;5:66. DOI: https://doi.org/10.3389/fsurg.2018.00066
Jr Fitzgibbons RJ, Saleno GM, Filipi CJ, Hunter WJ, Watson P. A Laparoscopic intraperitoneal onlay mesh technique for the repair of an indirect inguinal hernia. Ann Surg. 1994;219(2):144-56. DOI: https://doi.org/10.1097/00000658-199402000-00006
Coyne P, Nesbitt CI, Farook G. Laparoscopic repiar of perineal hernia using double-mesh technique: a case report. Ann Colorectal Res. 2015;3(1):e25481. DOI: https://doi.org/10.17795/acr-25481
Afify RY, Hamood M, Hassan M. The outcome of A. double mesh intraperitoneal repair for complex ventral hernia: A retrospective cohort study. Int J Surg. 2018;53:129-36. DOI: https://doi.org/10.1016/j.ijsu.2018.03.036
Robbins AW, Rutkow IM. Mesh-plug herniopalsty. Surg Clin North Am. 1993;73(3):501-12. DOI: https://doi.org/10.1016/S0039-6109(16)46033-0
Goldstein AL, Nevo N, Karin E. The use of Inlay bridge of the posterior fascia as adjuvants to Modified Rives-Stoppa repair for difficult abdominal wall hernias. Am Surgeons. 2022;89(11):4616-24. DOI: https://doi.org/10.1177/00031348221114027
Van Varseeveld OC, Koeijers GG, Rodriguez VIM. Abdominal wall reconstruction in abdominal wall endometriosis: a case report and literature review. Arch Plast Surg. 2025;52:76-81. DOI: https://doi.org/10.1055/a-2336-0073
Okuyan GC, Talu M. Evaluation of double mesh and intraperitoneal onlay mesh techniques in giant incisional hernias. J Clin Med Kaz. 2023;20(4):17-21. DOI: https://doi.org/10.23950/jcmk/13488
Murthy L, Raghu K, Rambhau P. Sandwich repair of incisional hernias. Global Jr Res Analysis. 2016;5(4):54-56.
Aubrey JM, Sharrak A, Opalikhin A, Zambito G, Banks-venegoni A. Combined open-robotc ‘Sandwich’ repair of flank hernia: a case series of 10 patients. Surg Endosc. 2025;39(2):786-91. DOI: https://doi.org/10.1007/s00464-024-11383-9
Downloads
Published
How to Cite
Issue
Section
