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

Abstract

Introduction: Apart from recurrence after ventral hernia repairs, other postoperative complications like seroma formation, hematoma, cellulitis, wound infection attributed largely to extensive dissection and tissue handling. Sublay technique has several advantages such as low rate of infection from subcutaneous tissues down to the mesh as it lies quite deep in the preperitoneal plane. Moreover the mesh implanted in the preperitoneal space unites and consolidates the anterior abdominal wall and also adheres to the posterior rectus sheath and renders it inextensible allowing no further herniation. The authors in this study tried to compare the pattern of wound complications and postoperative pain in sublay and onlay mesh repair for ventral hernia. Patients and Methods: A total of 200 patients with ventral hernias were enrolled and divided into main two groups; A and B. Group A patients were subjected to onlay mesh repair and Group B patients were subjected to sublay mesh repair. Operations were performed in Port-Fouad general hospital, Port-Fouad, Port-Said, Egypt and in the Al-Mahalla Al-Koubra general hospital, Al-Mahalla Al-Koubra, Egypt. End Points: The end points were of wound infection, mesh rejection and chronic postoperative pain. Results: There was no statistical difference between both groups regarding their demographic data such as age, sex, special habits and body mass index and co-morbidities. Patterns of mesh related wound complications as well as chronic postoperative pain were higher in onlay versus sublay repair with no statistical significance. Conclusion: sublay preperitoneal repair is a safe and an effective technique for ventral hernia surgery. Pattern of wound complications as postoperative wound infection, mesh removal and chronic pain are much less than when compared with the onlay maneuver.