Onlay versus sublay mesh repair for ventral hernia

Abstract

Background: Ventral hernia repair is one of the most common surgical operations performed all over the world. Onlay and sublay mesh repairs are the commonly performed techniques for the same. However, the debate still continues about the superiority of both techniques over each other. The aim of this study was to compare the outcome of the onlay versus sublay mesh repair for ventral hernia.Methods: A total of 100 patients with paraumbilical, epigastric, supraumbilical and incisional hernias (with defect size ≤4 inches) were divided into main two groups; A: onlay mesh repair and B: sublay mesh repair. Patients with uncontrolled diabetes and recurrent ventral hernia were excluded. Randomization was done using computer generated software. Patients were evaluated for operating time, postoperative seroma formation, wound infection, drain duration, post-op hospital stay and recurrence of symptoms. Ethical approval for this study was granted by the ethical review committee of Mysore Medical College, Mysore, Karnataka, India.Results: The incidence of post-operative seroma and wound infection was 6.52% and 4.35% in sublay group compared to 21.30% and 19.20% in onlay group which was statistically significant (p<0.05). Mean operating time was found to be more in sublay group than onlay group which was also statistically significant (72.3+9.23 vs. 65.25+10.58 minutes, p<0.05). Mean drainage duration (4.22+0.99 days vs. 5.97+1.24 days) and post-op hospital stay (4.8+1.51 days vs. 6.68+1.46 days) was low in sublay group compared to onlay group which was statistically significant (p<0.05). Recurrence in sublay group was 4.35% compared to 8.51% in onlay group which was not statistically significant (p>0.05).Conclusions: Even though operating time is longer, placement of mesh in sublay position is a better option than onlay placement in open ventral hernia repair because of lower complication rate and post-op morbidity.