What you’re describing would be called preperitoneal mesh placement via anterior approach.
The Kugel patch and the Prolene Hernia System (PHS) are examples. The Onstep procedure is another. There are others.
A hole is created in the abdominal wall to work through and a space is made between the peritoneum and the abdominal wall. The mesh is pushed through the hole and manipulated to spread out in that space over the area that the surgeon desires to cover.
I think that it has the same problems as laparoscopic mesh placement. The mesh is in the same general area and the body’s response is the same. It’s just another way to get the mesh in.
Here is a writeup of the Onstep procedure with illustrations.
I don’t think a mesh is a good option, but if I had to place one, I’d choose Onstep for sure. There is good experience with this mainly in Portugal and Denmark, even if on a worldwide basis that’s small yet.
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