Sublay versus onlay mesh repair of ventral hernia

Abstract

Ventral hernias are commonly encountered in surgical practice. The estimated incidence of ventral hernia is 15-20%. Although a wide variety of surgical procedures have been adopted for the repair of incisional hernia, but the implantation of prosthetic mesh remains the most efficient method of dealing with ventral hernia. Our study is to evaluate the technique of preperitoneal (sublay) mesh repair of ventral hernias and compare it to onlay mesh repair. The prospective study was carried out in 102 patients of incisional and paraumblical hernia.52 patients were managed by onlay mesh repair and 50 patients were managed by sublay mesh repair.Observation in both groups were made with regards to duration and ease of operation, placement and duration of drainage, woundcomplications, hospital stay, and recurrence. Follow up every three month for 12-24 months was done . In onlay group drain was removed after 2-5 days except one patient with large incisional hernia drain was removed after 14 days .In sublay group drain was removed after 2-3 days. Post operative complications like seroma & wound infection were comparable in both groups. In sublay group Seroma formation was 2%(one patient only) . Wound infection was2% (one patient only).No septic mesh was removed in the series. In onlay group seroma formation was24%(12 patients) most of seroma occur in large incisional hernias repair, wound infection was 4% (2 patient s)and one septic mesh was removed. In sublay recurrence rate was 0%,in onlay recurrence rate was 2%(one patient).ConclusionSub lay mesh repair is associated with less chances of seroma formation and almost no recurrence with low post operative complication like infection and wound edge necrosis.