Background Laparoscopic intraperitoneal onlay mesh (IPOM) repair is commonly performed for umbilical hernias, but postoperative seroma and contour-related bulging can affect patient satisfaction. Defect closure (IPOM-plus) aims to restore midline anatomy and reduce dead space, though concerns remain regarding early postoperative pain. Aim To compare defect closure (IPOM-plus) versus non-closure (bridged IPOM) in laparoscopic umbilical hernia repair with respect to seroma, bulging/pseudobulge, recurrence, and postoperative pain. Methods Forty adults undergoing elective laparoscopic umbilical hernia repair over a 6 months period from April 2024 – September 2024 were prospectively evaluated (n=20 per group). A dual mesh was placed intraperitoneally with absorbable tacker fixation in all cases; circular mesh sizes used were 12×12 cm or 15×15 cm. Outcomes were assessed up to 6 months, including pain measured using the visual analogue scale (VAS). Results Seroma occurred in 2/20 (10.0%) patients in the defect closure group and 8/20 (40.0%) in the non-closure group. Bulging/pseudobulge was lower with defect closure (3/20, 15.0%) than with non-closure (11/20, 55.0%). Recurrence at 6 months was uncommon (0/20 vs 1/20). Median VAS pain scores were higher after defect closure at POD1 and POD7, while pain scores were low by 6 months in both groups. Conclusion Defect closure during laparoscopic umbilical hernia IPOM reduced bulging/pseudobulge and showed a clinically meaningful reduction in seroma, at the expense of higher early postoperative pain. Early recurrence was low with both strategies.

Umbilical Hernia, IPOM-Plus, Defect Closure, Seroma, Pseudobulge, Postoperative Pain.