I do understand the problem of rectangular shape of the mesh, but a minimun of 5 cm all around is correct..so you should use what you can you can!!!

But Dr. Agresta, a rectangle mesh is longer on one side, so we get a 5-cm cover on that one side but not on the other !

you can shape it

There are circular, oval and rectangular meshes available. Depending on the the nature of protective barrier some are not to be trimmed (Parietene comp., Parietex comp.) and some can be trimmed anytime (Physiomesh, Ventralight ST..)

Depending on the type of defect (solitary vs. swiss cheese) trimming of the mesh makes sense. The number of fixating devices is 25% smaller when comparing rectangular to circular.Pain, cost, ... Trimming is wise.

The Magic 5cm overlap applies to small and medium size defects. The bigger the defect,or risk factors of the patient, the bigger overlap.                                           

For most of the defects 5 cm overlap is adequate but for larger defects it is better to use a larger mesh.My practice has been using a square mesh.

Trimming the corners of a rectangle (2a+2b) into a circle (Pi  x d) saves nearly 25% of tacking devices. There is a general consensus concerning the coverage of the whole scar.. When the hernia appeares within several years after the OP, one must assume that the whole scar is at risk, if it appears 15 years later I would concentrate only on local overlap of 5 cm.

if the size of the defect is less than 4 cm, then the mesh should be 4 cm wider than the defect on all sides (if defect is 2 cm mesh should be 4 + 2 +4 = 10 cm)

If the size of the defect is more than 4 cm, then the mesh should be 8 cm wider than the defect on all sides (if defect is 6 cm mesh should be 8 + 6 + 8 = 22 cm)

Habeeb, how much evidence do you have on that rule? Who published it and who has proven it? What about the patients characterics beyond the hernia margins (4cm in a 50KG Body are never the same as 4 cm in a 90 KG Body, etc.)

I completely agree with Dr. Kukleta. His answers express the concepts that I wanted to express, but He did it first and better than I would have done.

I do agree with Dr. Mohamed in the way that small hernias don't need the 5cm overlap (3-5cm is enough in a regular low-to-medium risk patient), but not with the 8cm overlap in larger hernias. Beware: when we increase the size of the mesh, we also increase the number of tackers and the complications associated with them. Also, there are evidences that confirm that the pain associated with the hernia repair is related with the mesh itself and the inflammatory/fibrotic reactions it causes. Dr. Kukleta made a very interesting point in differentiating body types: in a lean, small patient with a large hernia, a 8cm overlap could mean that you would not have the space to unroll the mesh and apply the tackers, or worst, you may risk the displacement of the mesh to the opposite side (because that's the one you see better!) when you tack the mesh.

pain is usually due to fixation of the mesh(tacks,sutures) and it is experienced in the immediate post op period.I donot think that mesh size is related to the pain.Could Dr Manuel site a ref. please.

Laparoscopic repair of incisional hernias should be done only in very selected cases, because when the open Rives technique is feasible it is largely preferable, since the mesh is not in contact with the peritoneal contents, and the incidence of subcutaneous seromas is much lower.

Dr. Prasanna Kumar Reddy, you are certainly right! The major causes of the pain after the hernia repair are due to the fixation material, but we must not forget that a foreign body (sometimes a very large and rigid one) is being introduced in the peritoneal cavity. As the authors cite in this publication, "There is considerable literature to support the fact that it is the mesh material itself that plays the significant role in postoperative pain, rather than the method of repair". We could also consider the shrinking of the mesh as a cause of late post-operative pain and not only of recurrences.

Article Complications of Incisional Hernia Repair

Thank you very much

I think that incisional hernia repair needs a tailored surgery and eclectic surgical behavior. Size an localization of defect "in primis", then patient's habitus . Overlap of 4-5 cm is correct in small-medium hernia size. In larger defects  with  elevated BMI  is difficult reach an optimal result with only laparosopic technique. In same cases i apply a combined technique: i begin with lap adhesiolisis and inspection of defect , then i do a short skin incision and a direct repair of aponeurotic wall. I use often Ramirez trick to consent medial slipping of anterior rectal sheet. After wall closure the repair is completed by apposition of intraperitoneal mesh by usual laparoscopic technique. This method is longer than laparoscopic but the results are good, expecially when the patient needs a body counturing. 

Dr. Bruno Benini: if the defect is not too large in width, you can approximate the fascia laparoscopically, of corse without causing undue tension, with interrupted sutures. I do it with so much PDS 0 figure-of-eight (tied extra corporeally) as needed before applying the mesh of the same size I would do if the defect was left intact. This technique does not replace the component separation technique, of course, but improves the abdominal wall function by approximating the medial borders of the recti. That small incision you refer is a possible way of contamination of the prosthesis.

is there any recommendation of mesh size after IPOM plus (after defect closure)?

Tailored approvh and 5 cm overlap are the same ,even after closure

We use a mesh to overlap the defect and 5 cm more on all directions. We usually reshape the mesh from a bigger one, even rectangular.