Does Mesh Location Matter in Abdominal Wall Reconstruction? A Systematic Review of the Literature and a Summary of Recommendations

Albino, Frank P.; Patel, Ketan M.; Nahabedian, Maurice Y.; Sosin, Michael; Attinger, Christopher E.; Bhanot, Parag

doi:10.1097/prs.0b013e3182a4c393

Cited by 131 publications

(84 citation statements)

References 45 publications

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“…Underlay or retrorectus mesh placement is associated with lower recurrence rates (20). The high incidence of recurrence of about 30-50% after anatomical repair and …”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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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.

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“…Underlay or retrorectus mesh placement is associated with lower recurrence rates (20). The high incidence of recurrence of about 30-50% after anatomical repair and …”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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“…The location of the reinforcement appears to influence outcomes. Underlay or retrorectus mesh placement is associated with lower recurrence rates [20]. The high incidence of recurrence of about 30-50% after anatomical repair and 1.5-10% following prosthetic mesh repairs was reported in literatures [11,21,22].…”

Section: Discussionmentioning

confidence: 97%

Onlay versus Sublay Mesh Repair for Ventral Hernia

Saber¹

2016

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Abstract:Introduction: Ventral hernia repair is among the most common surgical operations performed worldwide and the two operative techniques most frequently used in case of ventral hernia are the onlay and sublay repair. However, it remains unclear which technique is superior. The aim of this study was to compare the outcome of the onlay versus sublay mesh repair for ventral hernia. Patients and Methods: A total of 200 patients with paraumbilical, epigastric and supraumbilical incisional hernias were divided into main two groups; A; onlay mesh repair and B; sublay mesh repair. End Points:The primary end point of the study was recurrence of the hernia, defined as a clinically detectable characteristic swelling and diagnosed by the two authors. The secondary end points were operative time, drainage time, seroma formation and purulent wound infection. Results: The mean operative time for onlay repair was 67.04 ± 13.19 minutes while in sublay group was 93.26 ± 24.94 minutes ranged from 60 to 140 minutes. As regard the drainage time, the mean total time in days was 7.47 ± 1.7 days in onlay repair while in sublay group was 4.5 ± 1.1 days. Seroma formation after suction drain removal was observed in 6% patients in group A and in 2% in group B. Purulent wound infection was observed in 8% and 4% patients in group A and B respectively treated with dressing and proper antibiotic according to culture tests. Disease recurrence was observed in 8 % and 3 % patients of group A and B respectively. Conclusion: Sublay mesh repair is a good alternative to onlay mesh repair that may be applicable to all forms of ventral hernia. The mesh related overall complication rate is low such as drainage time, seroma formation and wound infection as well as the low recurrence rate. The authors concluded for trials on sublay mesh repair with a large number of cases and a longer period of follow-up.

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“…As is commonly the case though, mesh is frequently employed to provide additional structure and support to the musculofascial repair as a retrorectus sublay mesh. This placement is preferred as it is associated with lower ventral hernia reoccurrence rates [ 41 ]. The minimally invasive component separation technique uses tunneled incisions for external oblique aponeurosis release and thus preserves both the connection between the subcutaneous fat and the anterior rectus sheath and the myocutaneous perforator vessels originating from the rectus abdominis.…”

Section: Complex Abdominal Wall Defect Reconstructio Nmentioning

confidence: 99%

Negative Pressure Wound Therapy

Zomerlei

Janis

2016

Hernia Surgery

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Does Mesh Location Matter in Abdominal Wall Reconstruction? A Systematic Review of the Literature and a Summary of Recommendations

Abstract: Mesh reinforcement of a ventral hernia repair is safe and efficacious, but the location of the reinforcement appears to influence outcomes. Underlay or retrorectus mesh placement is associated with lower recurrence rates.

Cited by 131 publications

References 45 publications

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

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

Onlay versus Sublay Mesh Repair for Ventral Hernia

Negative Pressure Wound Therapy

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