A STUDY OF COMPARISON BETWEEN ONLAY VERSUS SUBLAY MESHPLASTY IN CASES OF VENTRAL HERNIA (UMBILICAL AND PARAUMBILICAL) AMONG ADULTS: AN ANALYTICAL STUDY CONDUCTED AT ONE OF THE TERTIARY CARE CENTRES OF NORTHERN PROVINCE IN INDIA

Abstract

Back ground: Hernia is the protrusion of whole or a part of a viscus through the wall that contains it. It can occur anywhere in the body, but more commonly occurs in the inguinal region and umbilicus. Umbilical hernias protrude directly through the umbilical tube, while paraumbilical hernias occur just adjacent to the umbilical tube. Repair of umbilical and paraumbilical hernias follow the same principle. Apart from the basic protocol of repairing the fascial defect and reinforcing the fascia with a mesh, the placement of the mesh also plays a crucial role in determining the outcome of the surgery and long term complications.Sublay versus onlay mesh placement is well debated.In this study we attempted to compare both the procedures in terms of operative difficulty, post-operative complications, drain out time,long term recurrence rates etc.in the last few decades mesh repair of hernia became the standard treatment in all types of hernia including para umbilical hernia (PUH),position of mesh placement either onlay or sublay still an issue of debate,in this study we trying to address advantages and disadvantages of each position.Materials and Methodology: in this study we recruited 30 patients with paraumbilical hernia, patients were randomly allocated according to mesh placement position into sublay group 15 patients and onlay group 15 patients,preoperative,operative and follow up data of all participants were properly presented and analyzed using the suitable statistical tests.Results:The mean operative time in the sublay group was 110.3 minutes,while in the onlay group it was 84.3 minutes respectively.Hospital stay in the onlay group was significantly longer compared to the onlay group (p=0.001). Duration for drain removal was significantly shorter in sub lay group.post-operative complications in the form of superficial wound infection occured in 4 patients of the onlay group and only 2 cases of the sublay group, seroma formation occured in 2 patients of the onlay group & 1 patient of the sublay group,While post-operative chest infection was encountered in 1 patient of the sublay group, No incidence of recurrence was recorded from both groups during the 6 month follow up. Conclusions: Both sublay and onlay mesh placement techniques are safe, both produced acceptable results, and are associated with comparable complications and recurrence rates.