Abstract
Background: An incisional hernia is a common complication of abdominal surgery with an incidence rate of two to 11%. Although there are various techniques described, the mesh repair has been the gold standard in the elective management of incisional hernias. But the best method of mesh placement is still debatable. Hence a study was conducted to compare the Retromuscular prefascial mesh placement with Onlay mesh placement in the treatment of incisional hernias.Methods: A prospective study was conducted in the Department of General Surgery in a tertiary center from November 2010 to May 2012. All patients with an incisional hernia underwent either Retromuscular prefascial mesh repair or onlay mesh repair. The nature of the previous surgery, size of the defect, operative, and postoperative complications were recorded. Mann Whitney test and Fisher’s exact test was used to evaluate the significance of the difference. A ‘p’ value <0.05 was considered significant.Results: A total of 60 patients were studied with 30 patients each in the Retromuscular prefascial group and the onlay group. Forty (67%) cases of incisional hernia were secondary to lower midline incision and hysterectomy was the most common surgery [30 patients (50%)]. The Retromuscular prefascial mesh group had significantly lesser postoperative complications (2/30 vs. 12/30; p=0.002; Fischer’s exact test) and seroma formation (1/30 vs. 8/30; p=0.02; Fischer’s exact test) compared to the onlay mesh group.Conclusions: Retromuscular prefascial mesh repair was equally effective but associated with fewer complications compared to onlay mesh repair.
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