Onlay vs retrorectus mesh placement for uncomplicated ventral hernia repair

Abstract

Background Ventral hernia such as paraumbilical and epigastric hernias are among the most common surgical problems as well as the most common surgical operations performed worldwide. The two operative techniques most frequently used in the case of ventral hernia are the onlay and sublay repairs. However, it remains unclear which technique of repair is superior. Objective The aim was to compare between two techniques of mesh placement in uncomplicated ventral hernias, onlay (mesh on external oblique) vs sublay (mesh in the retromuscular space). The patients included were evaluated for operating time, postoperative seroma formation, wound infection, drain duration, and postoperative hospital stay. Patients and methods Fifty adult patients with uncomplicated ventral hernia were included in this study and were managed at the Al-Azhar University Hospitals. The patients were divided randomly into two groups according to the surgical technique used for the repair, without any specific criteria used in selection for any technique as follows: Group A underwent onlay mesh repair and group B had sublay mesh repair. Results The mean operative time in patients treated with onlay mesh repair was 84.537±12.472 min (75–90) and in patients treated with sublay mesh repair was 93.438±15.536 min (80–100). As regards the drainage time, the mean total time in days was 7.532±2.472 days in onlay repair while in sublay group it was 4.153±1.251 days. Seroma formation after suction drain removal was observed in 12% patients in group A and in 4% in group B. Purulent wound infection was observed in 16 and 4% patients in group A and group B, respectively, and treated with dressing and proper antibiotic according to culture tests. Conclusion Sublay (retromuscular) mesh repair is a good alternative to onlay mesh repairs, and the authors suggest carrying out more trials on the retromuscular mesh repair technique to include a bigger number of cases and a longer period of follow-up.