Onlay versus Sublay Mesh Repair for Ventral Hernia

Abstract

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.

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

“…8 Study by Saber A et al found that the mean operative time for onlay repair was 67.04±13.19 minutes ranged from 45 to 90 minutes while in sublay group was 93.26±24.94 minutes ranged from 60 to140 minutes (P≤0.0001). 9 In previous studies, the mean operative time was longer in sublay than onlay techniques due to the time consumed to create the preperitoneal tunnel. 6,7,10 Our data came in agreement with these reported studies as the operative time in sublay group patients was much longer in the onlay technique.…”

Pattern of Wound Complications and Postoperative Pain in Sublay versus Onlay Mesh Repair for Ventral Hernia

“…The explanation of this reduced incidence of infection in sublay than in onlay technique that the former has several advantages, one of which being not transmitting the infection from subcutaneous tissues down to the mesh, as it lies quite deep in the preperitoneal plane [15,16,23,24]. Also, Milad and his colleagues reported that the retromuscular plane is highly vascular and helps preventing infection, and if any infection occurs in the subcutaneous plane, it will not affect the mesh, as the mesh is retromuscular in a deeper plane [1,25].…”

“…Hemostasis was secured and wound was closed over a suction drain. A dose of broad-spectrum antibiotic was given prior to anaesthesia [1].…”

“…All the patients were given 1gm 3rd generation cephalosporin antibiotic preoperatively at the time of induction and continued till the 5th postoperative day twice daily. The hospital stay of the patients was also recorded down [1].…”

“…Ventral hernia repairs are among the most common surgical operations performed worldwide and the incidence of post-operative wound-related complications due to mesh repair aimed at continuing research into the optimal method of treatment of these hernias [1]. Apart from recurrence other postoperative complications like seroma formation, hematoma, cellulitis, wound infection attributed largely to extensive dissection and tissue handling during hernia repair [2].…”