A Comparative study in elective repair of large incisional hernias using on- lay mesh vs. sub-lay mesh- A Meta-analysis

Abstract

Background: Ventral abdominal wall incisional hernia is defined as a defect in the musculo-fascial layers of the abdominal wall in the region of postoperative scar. There is a slight increase in the incidence of incisional hernia in the female gender. The higher percentage of incisional hernia in females might be due to laxity of abdominal wall muscles after multiple pregnancies and also increased incidence of obesity in females. Objective: To assess incisional hernia repair using two different techniques: on-lay mesh and sub-lay mesh, as regards operative time, postoperative recurrence, wound infection, seroma, hematoma and flap necrosis. Patients and Methods: The Pubmed, web of science and Scopus were searched on 15 March, 2022. The keywords incisional hernia, sub-lay mesh on-lay mesh, retromuscular mesh, polypropylene. Results and Conclusion: According to our results, there is a statistical difference between onlay and sublay regarding intra-operative time as sublay mesh is more time consuming. Regarding post-operative complications there is no statistical difference in recurrence, seroma, hematoma, flap necrosis and infection but there is a statistical difference regarding in hospital stay as patients with sublay repair stays less than onlay.

A Comparative Study of Elective Sublay Versus Onlay Repair for Non-complex, Small, and Medium-Size Incisional Hernia: Post-operative Complications in a Tertiary Hospital in Ranchi, India

“…Incisional hernia, as the name suggests, occurs through the previous surgical scar and can occur anywhere in the anterior abdominal wall [ 12 ]; its incidence is in the range of 2-11% to 10-20% [ 4 ]. The risk of developing incisional hernia is high in patients with a history of previous surgical site infection [ 7 ], tension closure of the abdominal wall, and other factors like obesity, smoking, and diabetes [ 6 ].…”

“…Apart from the technique used for previous operations and wound infections, associated factors like obesity, smoking, and chronic medical conditions like diabetes and COPD all lead to the formation of incisional hernias [6][7][8].…”

“…Since some of the studies have shown that the sublay technique has the edge over the onlay technique [ 9 ] and other studies have found no significant reduction in the incidence of complications [ 7 ], the ideal anatomical location for mesh placement is still in debate. So in this study, we have done a retrospective study of incisional hernia repair at Rajendra Institute of Medical Sciences (RIMS), Ranchi, India, between 2021 and 2023.…”