Comparative evaluation of sublay versus onlay meshplasty in incisional and ventral hernias

Abstract

Background: Hernia derived from the Latin word, is a protrusion of a viscus or part of a viscus through an abnormal opening in the walls of its containing cavity. Objectives of present study were to evaluate sublay Vs onlay meshplasty in incisional and ventral hernia and to compare and determine duration of operation and hospital stay, post-operative complications and recurrences.Methods: The study was conducted at Dr. D. Y. Patil Medical College and Hospital, DPU University, for a period of 2 years (from July 2015 - September 2017) and is a prospective and comparative randomized type of study using 100 cases (Group A Onlay and Group B Sublay - 50 each). The study was approved by the Institute’s Ethics Committee.Results: 100 patients were operated in our study. In group B, the mean operative time [70.72±18.56], and in group A mean operative time (50.96±12.61). The duration of hospital stay was an of average 7.62±1.78 days in group B, and an average hospital stay of 8.84±1.89 in group A. Suture site infection was18%. group A (26%) and group B (12%). Seroma was seen in 5 patients, group A (8 %) and in group B (2%). Flap necrosis was 8% in group A and in 6% in group B. 10 patients had wound dehiscence, group A (14%) and group B (6%). 4 patients were reported with mesh infection (6%) in group A and (2%) in group B. Recurrence was 1% group A.Conclusions: Sublay meshplasty is good alternative to onlay meshplasty that may be applicable to all forms of ventral and incisional hernias. The mesh related complication rate and recurrence was found to be minimal.

A comparative study of various techniques of incisional hernia repair in a tertiary care center at Bikaner (North-West Rajasthan)

“…27 On comparison of average duration of surgery our study was concordant to study by Baracs and Dhaigude who also showed shorter duration of surgery in anatomical repair compared to mesh repair and among mesh repair surgery by sublay technique was longer than onlay technique which could be explained with easier operative onlay technique. 17,28 Based on distribution of postoperative complications between anatomical and mesh repair groups our study is similar to the study by Luijendijk and Shiv Kumar but differs from study by Jehad who showed increased incidence of seroma formation in anatomical repair group. 11,16,21 Superficial wound infection was the second most common complication observed in our study.…”

“…On comparing seroma formation in onlay and sublay group our study was concordant with the study of authors Baracs, Lamani and Dhaigude who also observed increased incidence of seroma formation in onlay group. 17,28,29 In our study incidence of wound infection was 15% in onlay group while in sublay group it was 10% similar to the study by authors. 17,28,29 In terms of recurrence rate our study is comparable to the study by Luijendijk, Baracs, Kumar, Tulaskar and Jacobus who also found increased incidence recurrence in anatomical repair group compared to mesh repair.…”

“…17,28,29 In our study incidence of wound infection was 15% in onlay group while in sublay group it was 10% similar to the study by authors. 17,28,29 In terms of recurrence rate our study is comparable to the study by Luijendijk, Baracs, Kumar, Tulaskar and Jacobus who also found increased incidence recurrence in anatomical repair group compared to mesh repair. 11,21,22,28,30 Among the mesh repair groups in our study no recurrence has been observed while Kharde and Dhaigude have found higher recurrence in onlay group compare to sublay group in 6 months follow up period.…”

“…11,21,22,28,30 Among the mesh repair groups in our study no recurrence has been observed while Kharde and Dhaigude have found higher recurrence in onlay group compare to sublay group in 6 months follow up period. 17,31 In our study the average duration of hospital stay was higher in mesh repair group compared to anatomical repair group similar to the study by Baracs, Jehad and Kumar. 16,27,28 Similarly, onlay group had longer hospital stay compared to sublay group which was similar to the study by authors.…”

“…The mean age in our study was 47±8.54 years which was comparable with the study of Bhattaria (47 years), Ellis et al (49.4 years), Jehad (50.5 years) and Dhaigude (49.46%) and differs from the study of Garg where the mean age was 23.82±3.14 years which is lesser than our study. [14][15][16][17][18] The sex incidence of incisional hernia in our study was 1:2.3 (M: F) showing a female preponderance. This was likely because of laxity of abdominal muscles due to multiple pregnancies and also an increased incidence of obesity in females.…”