Onlay Group Research Articles

Efficacy comparison between Mathieu combined urethral plate incision and onlay island flap urethroplasty for distal hypospadias in patients with urethral plate stenosis.

The aim of the study was to compare the efficacy of Mathieu combined urethral plate incision (Mathieu-IP) versus onlay island flap urethroplasty in patients with distal hypospadias complicated by urethral stenosis. The clinical data of 70 patients with distal hypospadias complicated by urethral plate stenosis treated in the Department of Urology, Anhui Provincial Children's Hospital (Hefei, China), from May 2019 to May 2022, were retrospectively analyzed. Thirty-eight patients underwent Mathieu-IP (Mathieu-IP group) and 32 underwent onlay island flap urethroplasty (Onlay group). Follow-ups at 1 month, 6 months, and 12 months postoperatively assessed operative time, complications, urethral meatus morphology, and family satisfaction. The Mathieu-IP group had significantly shorter operative time (mean ± standard deviation [s.d.]: 81.58 ± 5.18 min) versus the Onlay group (mean ± s.d.: 110.75 ± 6.05 min; P < 0.05). Surgical success rates were 78.9% (Mathieu-IP group) and 75.0% (Onlay group), with no significant difference ( P > 0.05). Complications were comparable between the groups. The Mathieu-IP group resulted in a vertical slit-shaped urethral meatus in 89.5% versus 13.8% in the Onlay group ( P < 0.05). Family satisfaction with general penile appearance and skin shape showed no significant differences, but the Mathieu-IP group had higher satisfaction with meatal position ( P < 0.05). Mathieu-IP offers simplicity, safety, and shorter operative time compared to Onlay. Both the techniques effectively treat urethral plate stenosis in distal hypospadias, with reduced postoperative complications compared to tubularized incised plate urethroplasty. Mathieu-IP results in a vertical slit-shaped urethral meatus which enhances urinary stream, indicating its potential for broader adoption.

A Comparative Study of Elective Sublay Versus Onlay Repair for Non-complex, Small, and Medium-Size Incisional Hernia: Post-operative Complications in a Tertiary Hospital in Ranchi, India.

The most difficult hernia surgery is the repair of the ventral hernia, which is caused by aberrant organ or tissue protrusions through the abdominal wall. Factors like obesity, smoking, and chronic medical conditions contribute to their formation. Surgical strategies have evolved from anatomical repair to mesh hernioplasty, with mesh placement playing a significant role in outcomes. The ideal anatomical location for mesh placement remains debated due to varying results. So, the objective of the study is to compare early postoperative complications, surgical site infection, and incidence of recurrence between sublay and onlay mesh placement repair of incisional hernias of <10 cm in diameter, at a tertiary hospital in Ranchi. This retrospective comparative study was conducted over a period of January 2022 to January 2024 at the Rajendra Institute of Medical Science, Ranchi, India. During the study period, 96 patients were operated on, and their demographic details, along with their position of mesh placement and postoperative complications (seroma formation, wound infection, postoperative hospital stays, and recurrence), were retrieved from the hospital data. Comparisons between onlay and sublay groups in terms of post-operative complications were made. Within the study period, a total of 96 patients were operated on for incisional hernia. In this study, 36 (37.5%) were male and 60 (62.5%) were female, with a male-to-female ratio of 0.6:1. Out of the total number of patients, 56 (58.4%) had a past history of emergency surgery. It was observed that there was a higher incidence of seroma formation in the onlay group compared to the sublay with a statistical significance p-value of 0.027. The incidence of wound infection was found to be statistically significant (p-value = 0.035) between the onlay and sublay groups. In a period of six-month follow-up, three patients of the total study population had an incidence of recurrent incisional hernia, of which two from the onlay group and one from the sublay group were present, and there was no statistical significance (p-value > 0.5). Based on our retrospective analysis, we can say that there is a lower incidence of postoperative complications and recurrence in sublay repair, along with a shorter postoperative hospital stay, making it a preferred method of repair over onlay.

Reverse shoulder arthroplasty for patients with cuff tear arthropathy: do clinical outcomes differ by inlay vs. onlay design?

The influence of position of the humeral tray (inlay or onlay) on clinical outcomes in reverse shoulder arthroplasty (RSA) is a topic of debate. The purpose of this study was to compare clinical and radiographic outcomes of patients with cuff tear arthropathy treated with RSA systems with inlay or onlay humeral tray design, similar neck-shaft angles, and lateralized glenospheres. This was a retrospective study of prospectively obtained data from 1 tertiary care center. We identified all patients who underwent primary RSA between 2009 and 2017 (N=511). We included 102 patients with diagnosed cuff tear arthropathy treated with RSA prostheses with a lateralized glenosphere and 135° neck-shaft angle (with either an inlay or onlay humeral tray design) who had a minimum of 2 years of follow-up (mean, 44months; range, 24-125months). Sixty-three patients (62%) had an inlay humeral tray (inlay group) and 39 (38%) had an onlay tray (onlay group). All patients underwent preoperative and postoperative evaluations, including measures of patient-reported outcomes (PROs), shoulder range of motion (ROM) testing, and radiographic imaging. Clinical relevance of changes in PROs and ROM was evaluated using published values for minimal clinically important differences. The 2 groups did not differ by demographic characteristics except for a higher proportion of women in the inlay group (75%) than in the onlay group (56%) (P=.04). Preoperative PROs and ROM were not significantly different between groups. At final follow-up, PROs and ROM were not different between groups in terms of statistical significance or clinical relevance. We found no significant differences in the rate of baseplate loosening (inlay, 3.2% vs. onlay, 5.1%, P=.63), revision surgery (inlay, 0% vs. onlay 5.1%, P=.07), acromial stress fracture (inlay, 3.2% vs. onlay, 5.1%, P=.63), prosthesis dislocation (inlay, 0% vs. onlay, 2.6%, P=.20), or scapular notching (inlay, 21% vs. onlay, 7.7%, P=.08). At 2-year minimum follow-up, the position of the humeral tray in RSA prostheses (either inlay or onlay) for cuff tear arthropathy was not associated with PROs, shoulder ROM, or rates of complications, including baseplate loosening, acromial stress fracture, and scapular notching.

No clinical difference in outcomes between inlay and onlay arthroscopic biceps tenodesis techniques during rotator cuff repair

BackgroundBoth inlay and onlay arthroscopic biceps tenodesis (ABT) are common procedures performed during rotator cuff repair. The inlay method involves creating a bone socket in the bicipital groove to secure the long head of the biceps tendon (LHBT) using an interference screw. The onlay method utilizes a suture anchor to secure the LHBT on the surface of the bicipital groove. Little is known on the long-term differences in patient reported outcomes (PROs) between these two techniques. The primary purpose of this study was to compare PROs of inlay versus onlay ABT with a minimum follow-up of two years. Secondary aims were to evaluate the impact of rotator cuff tear size on outcomes and compare rates of complications between the two techniques. MethodsA retrospective chart review was performed to identify patients who had an ABT during a full-thickness rotator cuff repair. Any symptom specific to the biceps were noted, including pain and cramping, Popeye deformity, or revision surgery. Complication rates were compared between groups. The VAS pain score, ASES, SANE, and VR-12 scores were compared at two years. The impact of rotator cuff tear size was analyzed by categorizing into small/medium or large/massive based on operative reports and arthroscopic images. ResultsThere were 165 patients identified (106 in the inlay group and 59 in the onlay group). No revision surgeries were performed secondary to the biceps tendon in either group. Eleven patients (10%) in the inlay group complained of biceps pain or cramping compared to 2 patients (3%) in the onlay group (p = .11). One Popeye deformity was noted in each group (p = .67). No significant differences were found between groups for VAS (p=.41), ASES functional (p = .61), ASES Index (p = .91), SANE (p = .09), VR-12 PCS (p = .77), or VR-12 MCS (p = .09). Rotator cuff tear size within the groups also did not demonstrate statistical significance. ConclusionNo clinical differences or complications were found at minimum two-year follow-up between inlay and onlay arthroscopic biceps tenodesis in patients undergoing rotator cuff repair when controlling for tear size. The clinical relevance suggests either technique is effective and can be based on surgeon preference.

Fracture Resistance of Premolars Restored with Inlay/Onlay Composite and Lithium Disilicate CAD/CAM Block Restorations (An In Vitro Study)

Aim: To assess the fracture resistance of Premolars restored with inlay and onlay composite and E-max CAD/CAM block restoration.&#x0D; Material and method: Randomly, fifty maxillary premolar teeth were separated into three major groups: The first group was left unaltered (control group), while the other two groups were prepared with inlay and onlay cavities and restored with lithium disilicate blocks (IPS E.max CAD) and ceramic blocks (Cerasmart). Restorations were bonded using adhesive resin cement (RelyX Ultimate). All samples were thermocycling 500 cycles, between 5 to 55°C, and the cycle time was set at the 30s. The specimen was undergone compressive axial loading in a universal testing machine till the fracture occurred. The result was analyzed using one-way ANOVA, and LSD tests with a significance level set at 0.05.&#x0D; Result: There were no significant differences in means between the control group and the inlay groups that were restored with Emax and Cerasmart (P &gt;.05).but, the control group has significantly higher means than onlay groups restored with Emax and Cerasmart (P&lt; .05). The two materials show comparable results in both designs.&#x0D; Conclusion: The fracture resistance of inlay-prepared teeth showed comparable strength to the intact teeth. Conversely, the fracture resistance of onlay-prepared teeth is comparatively lower than intact teeth. The two materials show comparable results irrespective of cavity design.

Implants Placed with a Ring Technique Using Inlay and Onlay Block Xenografts in the Mandible of Rabbits

Background: Xenogenous bone has been proposed as an alternative to overcome the disadvantages of autogenous grafting. The aim of the present study was to study bone dynamics at inlay and onlay xenografts used for bone augmentation applying a ring technique. Methods: The bone at the lateral surface of the mandibular angle of 12 adult male New Zealand White rabbits was exposed bilaterally. The cortical layer received multiple perforations on one side of the mandible, and a xenograft block of collagenated cancellous equine bone, 7 mm in diameter and 3 mm in width, was fixed on the prepared surface using an implant (onlay group). On the opposite side, a defect 7 mm in diameter and 3 mm in depth was prepared, and the xenograft block was adapted to the defect and fixed with an implant (inlay group). Results: After ten weeks of healing, in the onlay grafts, new bone was mainly formed on the trabeculae surface, reaching in some specimens the most coronal regions of the block. In the inlay grafts, new bone was found arranged on the trabecular surfaces but also occupying the spaces among the trabeculae. The entrance of the defect was often found close to the top of the block by newly formed bone. A higher percentage of new bone was found in the inlay (19.0 ± 9.3%) compared to the onlay (10.4 ± 7.4%) groups (p = 0.031). The mean gain in osseointegration at the implant in relation to the base of the original 3 mm deep defect was 0.95 ± 1.05% in the onlay group and 0.78 ± 0.71% in the inlay group (p = 0.603). Conclusion: The inlay grafts exhibited a higher new bone percentage than the onlay block grafts possibly due to the defect conformation that presented more sources for bone growth. The trabecular conformation and the composition of the grafts made possible the expression of the osteoconductive properties of the material used. This resulted, in several specimens, in the growth of bone on the graft trabeculae toward the most superior regions in both groups and in the closure of the coronal entrance of the defects in the inlay group. The clinical relevance of this experiment is that the ring technique applied as an inlay method could be suitable for bone augmentation.

Histological Comparison of Collagenated Cancellous Equine Bone Blocks Used as Inlay or Onlay for Lateral Bone Augmentation in Rabbits.

The conformation of the recipient site for an inlay graft presents an increased contact with the parent bone compared to an onlay graft. This might favor bone growth within the inlay compared to onlay grafts. Hence, the objective of this study was to compare the bone incorporation and remodeling processes of xenogeneic en bloc grafts placed using two bone grafting techniques, i.e., onlay vs. inlay. In this prospective, randomized, split-mouth study (test and control sides in the same animal), two bone grafting techniques were comparatively evaluated. The lateral aspect of the rabbit mandible was used as the recipient site, bilaterally. On one side of the mandible, the cortical bone was perforated with drills to allow a better bone formation from the bone wound and the marrow spaces. A xenogeneic bone block was fixed in the center of the prepared region, representing the onlay site. On the other side of the mandible, a 7 mm wide and 3 mm deep circumferential defect was prepared using trephines and drills. A xenogeneic bone block was fixed in the center of the defect, representing the inlay site. Two healing periods were applied in the study: 2 and 10 weeks, each represented by 10 rabbits (n = 10 for each period). After 2 weeks of healing, the mean percentage of new bone was 10.4% and 23.3% at the onlay and inlay grafts, respectively (p = 0.022). After 10 weeks of healing, new bone increased to 13.2% at the onlay sites and 25.4% at the inlay sites (p = 0.080). In the 10-week period, the inlay grafts presented a homogeneous growth of new bone in all regions, while in the onlay grafts, low percentages of new bone were observed in the external regions. The percentage of new bone increased faster and was higher in the inlay grafts than in the onlay grafts. This outcome might be related to the self-contained conformation of the recipient site in the inlay group, which offered more sources for new bone formation compared to the one-wall conformation of the recipient sites in the onlay group. The osteoconductive properties of the biomaterial allowed the newly formed bone to reach the most peripheral regions in both groups. The osteoconductive properties of the biomaterial, together with the protection offered by the collagen membrane, allowed marginal closure of the defects by newly formed bone in the inlay group.

Comparative Evaluation of Onlay vs Sublay Mesh in Treatment of Ventral Hernias

Abstract Background Hernias of the anterior abdominal wall, or ventral hernias have a various type that can be categorized into primary ventral hernias which include two subtypes lateral ventral hernia, and midline ventral hernias, and incisional hernias (acquired hernias) is another type according to the location, occur at the site of a pervious surgical scar. Objective To compare the outcome of the onlay versus sublay mesh repair for ventral hernias in terms of mean operative time, frequency of post-operative wound infection, seroma formation, hematoma formation, flap necrosis, mesh infection, hospital stay and time for drain removal. Patients and Methods This study will be conducted on 30 patients presenting to Ain shams University hospitals with uncomplicated ventral hernias starting from February 2021 till July 2021. Results Regarding the post operative complications, Seroma formation was more in the onlay group and this was statistically significant. Other post operative complications like wound infection, flap necrosis, Mesh infection, hematoma formation was more in the onlay group but were found to be statistically insignificant in the present study. Regarding the time taken for drain removal was more in the onlay group and this was statistically significant. Conclusion Sublay mesh repair is a good alternative to onlay mesh repair. This study advocates this method of ventral hernia repair, as it is applicable to all sites of ventral hernia. The mesh is mostly hidden and anchored behind the rectus sheath, the complication rate is low, and there is low recurrence rate. Finally, we suggest carrying out more trials on the sublay mesh repair technique to include bigger number of cases and longer period of follow-up.

Comparative Study between Onlay and Sublay Placement of Polyproline Mesh in Ventral Hernia Repair

Abstract Background Ventral hernia repair is one of the most common surgical operations performed all over the world. Onlay and sublay mesh repairs are the commonly performed techniques for the same. However, the debate still continues about the superiority of both techniques over each other. The aim of this study was to compare the outcome of the onlay versus sublay mesh repair for ventral hernia. Aim of the Work The purpose of this study is to compare between two techniques of mesh placement in uncomplicated ventral hernias, onlay (mesh on external oblique) versus sublay (mesh in the retromuscular space) regarding complications (superficial skin infection, seroma collection, operative time, hospital stay and 18 months recurrence rate. Patients and Methods The study frame is two years starting from August 2019 to August 2021 in general surgery department at Ain shams university hospital a. Total 60 adult patients who are scheduled to undergo hernioplasty for ventral abdominal wall hernias, 30 are included group A (onlay) and 30 in group B (sublay). Results Maior wound infection was 10% in the onlay group in coparison by the 3.3% of sublay group. Seroma is 33.3% in onlay group while 26.7% in sublay group. Recurrence rate is 6.7% in onlay while 3.3%in sublay group. Conclusion Our study revealed that ventral hernias are common in females more than males mainly in the fifth decade of life. Although there are many methods in repair such herniorraphy which associated with a high rate of recurrence so mesh repair is the best in such cases. We have found that sublay hernioplasty is better than onlay hernioplasty according to the post-operative complications such as recurrence, seroma formation and wound infection. However sublay hernioplsaty takes longer operative time than the onlay technique due to the disscection to get the retromuscular space, no significant statistical difference in the operative time., no significant blood loss and hospital stay between the two techniques.

Ventral Hernias in Kalyana Karnataka Teaching Hospital: A Prospective Study.

A ventral hernia is a protrusion of the abdominal viscus through the anterior abdominal wall occurring at any site other than the inguinal and femoral areas and is a common problem encountered by surgeons.&#x0D; Aims &amp; Objective: Due to the lack of prospective cohorts to determine the natural history of untreated ventral hernias, most surgeons recommend that these hernias be repaired as soon as they are discovered. The purpose of this study was to determine the proportion of ventral hernias occurring in both sexes, various age groups, various risk factors, and complications, as well as their clinical presentations and treatment.&#x0D; Material and Methods: During the period August 2020 to August 2021 (12 months), a prospective study was conducted at our tertiary care hospital. The study included 50 cases of anterior abdominal hernias excluding groin hernias and posterior abdominal wall hernias. A detailed history and a thorough clinical examination were used to collect data. In the proforma, data was entered, tabulated, and analyzed using statistical software (SPSS 2015).&#x0D; Results: Ventral hernias accounted for 5% of surgical admissions. Among the ventral hernias, para umbilical hernias were the most prevalent (48%). An infra umbilical midline herniation accounted for 36% of cases, followed by an umbilical region herniation in 18% of cases. Constipation and obesity were found to be the major risk factors. Most defects are small (&gt;2cm). 48% of inlay mesh repairs were made.&#x0D; Conclusion: 50 cases of ventral hernias were studied in the present study, which was conducted in our tertiary care hospital. Five percent of all admissions to the surgical ward were due to ventral hernias. The females to males ratio was 1:17, and the mean age was 41. The mean total duration for surgery in sublay group was 75.4±9.23 minutes compared to 63.7±10.58 minutes in onlay group, which was statistically significant (p&lt;0.05).&#x0D;

Poster 105: Rotator cuff healing using demineralised bone fibers in ovine infraspinatus tendon models

Objectives: Rotator cuff tears are a common cause of shoulder pain and functional deficits. Although surgical repair is often able to restore function and resolve pain, high rates of postoperative structural failures have been reported. To improve the outcomes and reduce re-tear rates biologic tissue scaffolds have been used to augment and reinforce the primary tendon repair by providing mechanical support of the initial repair and ideally improving the rate and/or quality of biological healing at the tendon-bone interface. Demineralised bone fibers (DBF) are bone collagen and can be formed into a patch providing a scaffold and inductive bone morphogenetic proteins known to facilitate healing. This study evaluated the in vivo response of human DBF Patches (hDBF-P) as an onlay over the infraspinatus tendon (IST) and at the tendon-bone interface in an ovine model. Methods: The hDBF-P was characterised using stereozoom (Figure 1A) and environment electron microscopy (Figure 1B). The osteoinductivity (OI) was evaluated in the standard nude rat intramuscular implantation (IM) model at 28 days using mCT and paraffin histology. A bilateral model of an onlay or an enthesis repair was performed in 12 adult wethers following ethical approval. Four groups were evaluated at 6 and 12 weeks (n=3 per time point): Onlay control and hDBF treated; Enthesis repair control and hDBF treated. The onlay model simulated a tendon injury by 4 longitudinal slits along the IST and lateral drill holes in the proximal humerus in the onlay control group [1]. In the onlay treated group the hDBF-P was hydrated in saline and secured to the IST with interrupted 2-0 non-resorbable sutures (Figure 2A). On contralateral side, the central third of the IST was sharply dissected, the footprint burred, and 2 medial row anchors inserted. The sutures were passed through the IST in the enthesis repair control group. In the enthesis repair treatment group, the sutures were passed through the hDBF-P which was placed at the tendon bone interface followed by sutures through the IST. Two lateral push lock anchors were used for a suture bridge (Figure 2B) in the control and treated groups. Endpoints included clinical recovery, macroscopic dissection, 3T MRI, radiographs, mCT and paraffin histology processing, H&amp;E staining, and light microscopic evaluations to assess local cell and tissue responses and healing. Results: OI was confirmed on IM implantation in nude rats. The sheep recovered uneventfully with no adverse events macroscopically or radiographically. MRI in the onlay control group revealed little response and no increase in tendon thickness which was confirmed histologically. In contrast the onlay hDBF-P treated demonstrated increased tendon thickness and hDBF resorption with time. Histology showed some initial inflammatory cells that decrease with time in the onlay group. MRI in the hDBF-P treated enthesis group supported increased activity at the bone interface at 6 and 12 weeks compared to controls. Histology at the interface with hDBF-P showed evidence of new bone formation at 6 weeks that matured with time support enthesis reformation. Conclusions: hDBF-P is a collagen graft composed of demineralized bone fibers that have osteoconductive and osteoinductive potential. When formed into a patch, this implant provides a scaffold that can participate with the local biology. hDBF-P used as on-lay in a tendon injury model increased tendon thickness. hDBF-P when used at the interface between the tendon and bone facilitated enthesis reformation through its conductive and inductive potential as well as scaffold architecture. DBF patches represent an exciting allograft implant with the potential to address the clinical problems in rotator cuff surgery. Literature cited Van Kampen, C., et al. (2013). Tissue-engineered augmentation of a rotator cuff tendon using a reconstituted collagen scaffold: a histological evaluation in sheep. Muscles, ligaments and tendons journal, 3(3), p.229.

Comparison between Sublay &amp; Onlay Mesh hernioplasty in Ventral Wall Abdominal Hernia Repair

Background &amp; Aim: Onlay and sublay repairs are the two surgical methods most commonly employed in ventral hernia patients. The repair of a ventral hernia is one of the most common surgical procedures performed globally. The results of simple ventral hernia onlay and sublay mesh repair methods were compared in this study to compare the results of onlay and sublay mesh ventral incisional hernia repair procedures. To investigate the frequency of seroma, wound infection, and wound disruption in patients with ventral abdominal hernias who had onlay and sublay mesh plasty. Incisional hernia (IH) is a very common surgical complication. Study design: Prospective Randomized Control Trial Place and duration of study: This study was done in department of General surgery at Central Park teaching Hospital, Lahore during a period of 4 months that span from October 2021 till January 2022. Methodology: This prospective research included 100 adults with primary or secondary uncomplicated ventral hernias. The onlay mesh repair procedure was used in both groups B (n = 50) and A (n = 50). We randomly assigned participants to one of two therapy groups using a computer-generated randomization process. The procedure's length, the length of the drain, the duration of any wound infections, the length of the post-op hospital stay, and any short-term recurrence were all noted. Results: When compared to the sublay group, the onlay group had a substantially shorter median operational time (52 vs. 91 min., respectively). However, in terms of wound complications and postoperative pain, the sublay group beat the control group significantly. Disease recurrence occurred in 8% and 3% of patients in groups A and B, respectively. Practical Implication: Sublay mesh repair, which is an alternative to onlay mesh repair, can be used to treat all types of ventral hernias. Conclusion: Sublay mesh repair, which is an alternative to onlay mesh repair, can be used to treat all types of ventral hernias. Mesh-related issues are associated with long drainage times, seroma development, wound infection, and recurrence. In terms of postoperative discomfort and wound complications, sublay mesh repair is preferred than onlay mesh repair for treating incisional hernias. The recurrence rates of the two procedures are comparable. Keywords: Ventral Hernia, Onlay Mesh Repair, Sublay Mesh Repair

Radiographic evaluation of the tenting screw technique in horizontal alveolar bone augmentation: A retrospective study

To radiographically analyze the effects of tenting screw technique (TS) and onlay bone grafts (OG) in horizontal bone augmentation. Patients receiving horizontal bone augmentation by TS or OG were selected. The clinical outcomes and cone beam computed tomography (CBCT) data were documented pre-grafting, immediately post-grafting, before and after implantation. The survival rates, clinical complications, alveolar bone width, and volumetric bone augmentation were evaluated and statistically analyzed. A total of 25 patients and 41 implants were involved in this study, with no grafting failures observed in either the TS group (n = 20) or the onlay group (n = 21). Volumetric bone resorption rate in the TS group (21.34%) was significantly lower than that of the OG group (29.38%). In addition, significant horizontal bone gain was achieved in both groups (TS: 6.15 ± 2.12 mm; OG: 4.86 ± 1.40 mm) during the recovery period, with higher gain in the TS group. No apparent statistical difference in terms of volumetric bone gain was observed between the TS (748.53 mm3 , 607.47 mm3 ) and OG group (811.77 mm3 , 508.49 mm3 ) immediately post-grafting or after the recovery period. Both TS and OG achieved satisfactory bone augmentation effects, yet TS resulted in more bone augmentation and better stability than OG, with a reduced use of autogenous bone. Overall, the tenting screw technique can serve as an effective alternative to autogenous bone grafts.

COMPARATIVE STUDY BETWEEN ONLAY AND SUBLAY MESH REPAIR IN THE TREATMENT OF VENTRAL HERNIAS

Objectives: To compare the outcomes of Onlay and Sublay mesh repair in the treatment of ventral hernias in terms of duration of surgery and early postoperative complications like seroma, surgical site infections, ap necrosis. Design : Material and method: Observational Comparative study. From 1st Sept 2021 to Sept 30th 2022, a one prospective study was done at a rural medical college. A total of 50 patients with ventral hernias meeting the inclusion &amp; exclusion criteria were enrolled in the study, with 25 patients in each group. Data was recorded in proformas. The data was analyzed using SPSS version 22. Out of the 50 patients enrolled in Results: the study, 25 patients underwent Sublay Mesh repair &amp; 25 patients underwent Onlay Mesh Repair. The most common post op complication observed in our study was seroma , which was seen in 5 patients: 1 (4%) were in Sublay group and 4 (16%) in Onlay mesh repair group. Wound infection was seen in 3 cases. Out of these, 1 (4%) were in Sublay group and 2 (8%) were in Onlay group. Flap necrosis was seen in 4 cases , all belonging to Onlay group The mean duration of surgery was 67 minutes in Onlay group while the mean duration of surgery was 78 minutes in Sublay group. Our study concludes that Sublay Mesh repair is superior to Onlay Mesh re Conclusion: pair in terms of post operative complications, although associated with a longer duration of surgery

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

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 &amp; 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.

Onlay Versus Sublay Mesh Repair for Incisional Hernias: A Systematic Review.

Incisional hernias are a common problem following major abdominal surgery. There are numerous surgical techniques described in the existing English scientific literature with different planes for mesh placement. The current review aims to compare onlay versus sublay repair in managing incisional hernias. A systematic literature search was conducted on Embase, the Cochrane Library, PubMed, and Medline to identify randomised controlled trials (RCTs) comparing onlay versus sublay mesh repair for incisional hernias. We identified six RCTs that included 986 patients, of whom 503 were in the onlay group and 485 were in the sublay group. There was no statistically significant difference in hernia recurrence between the onlay and sublay groups (odds ratio (OR): 1.3 (0.49-3.47), 95% confidence interval (CI), p=0.60). Seroma formation was significantly higher in the onlay group (OR: 2.85 (1.74-4.67), 95% CI, p<0.0001). There were 45 reported cases of surgical site infection (SSI). There was no significant difference between the two groups (OR: 1.46 (0.44-4.84), 95% CI, p=0.54). Haematomas were reported in 11 cases, and there was no significant difference between the two groups (OR: 2.13 (0.56-8.19), 95% CI, p=0.27). Four RCTs reported the length of the hospital stay. There was no significant difference between the two groups (mean difference (MD): 0.53 (-0.16-1.22), 95% CI, p=0.13). We failed to draw conclusive clinical recommendations due to the variability in the included RCTs. We recommend well-structured, large-volume RCTs to better compare these two surgical techniques.

On-Lay versus Sub-Lay Mesh Repair for Ventral Hernia: A Retrospective Cohort Study

Background: The most feared complication of hernia surgery is recurrence. There is no standard technique by which recurrence can be avoided. Objective: This study was conducted to test the hypothesis of whether the outcomes of sub-lay mesh are better than on-lay mesh repair for ventral hernias. Methods: This retrospective cohort study was conducted on patients who underwent open ventral hernia repair from 1st June 2016 - 31st April 2021. The primary outcome was recurrence and secondary outcomes were operative time, Surgical Site Infection (SSI) within 30 days, and seroma. Results: A total of 187 patients underwent ventral hernia repair and 69 were included in the study i.e. 35 in the sub-lay and 34 in the on-lay group. Both the groups were comparable for the baseline variables i.e. age, gender distribution, BMI, type of hernia, and content, with mean ± standard deviation age of 48.89 years ± 15.32 in the sub-lay and 52.7 ±12.3 in the on-lay group; however, the on-lay mesh was observed to be a preferred approach in patients with obesity or small defect &lt;5 cms. No statistically significant difference was observed between sub-lay and on-lay groups for recurrence (2.9% vs. 5.7%, p-value 0.51), SSI (8.6% vs. 2.9%, p-value: 0.31), Mesh infection (2.9% vs. 2.9% p-value: 0.74), duration of surgery (median: 120 vs. 121 minutes, p-value 0.36) and seroma formation (2.9% vs. 2.9%, p-value 0.74), respectively. Conclusion: This study demonstrates no significant differences between sub-lay vs. on-lay mesh placement in terms of recurrence, seroma formation, and operative time; however, with the slightly higher (statistically insignificant) frequency of SSI in the sub-lay group.

Onlay Versus Inlay Biceps Tenodesis for Long Head of Biceps Tendinopathy: A Systematic Review and Meta-analysis.

Proximal biceps tenodesis is a common surgical treatment of tendinosis of the long head of the biceps tendon. Two of the most common techniques incorporate onlay and inlay fixation methods, which can be done arthroscopically or open and in a variety of anatomic locations. The purpose of this meta-analysis was to compare the clinical outcomes between onlay versus inlay humeral fixation for biceps tenodesis for long head of the biceps tendon pathology. A literature search was conducted using PubMed, EMBASE, and Cochrane Library. Only studies reporting outcomes and complications after onlay and inlay biceps tenodeses were included. Six studies with a total of 418 patients (252 onlay, 166 inlay) with a mean age of 56.84 years were included. Visual analog pain scale scores, Constant score, and American Shoulder and Elbow Surgeons shoulder score did not differ. "Popeye" deformity was found in 17 patients (7.80%) in the onlay group and in 15 patients (11.28%) in the inlay group (odds ratio, 0.28; P = 0.07). No difference in postoperative cramping or failure rates was found. Both onlay and inlay biceps tenodeses result in improved clinical outcomes and are at low risk of Popeye deformities, with no statistically significant differences between either method. Additional studies are required to assess the clinical significance of these differences.

Inlay versus onlay humeral design for reverse shoulder arthroplasty: a systematic review and meta-analysis.

Since the introduction of the Grammont-style reverse total shoulder arthroplasty, the humeral stem design has been modified with improved clinical outcomes. Two distinct humeral designs have been used extensively: the inlay design, in which the humeral tray is seated within the metaphysis, and the onlay design, in which the humeral tray sits on the metaphysis at the level of the humeral neck cut. The purpose of this systematic review was to determine whether there are differences in clinical outcomes and complication rates between these designs. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used to perform this systematic review. A search of MEDLINE, PubMed, and Embase was performed to identify all studies comparing the clinical results of both humeral designs. Primary outcomes included patient-reported outcome measures, shoulder range of motion, and incidence of complications. From the 156 identified publications, 12 studies were included in the final review. A total of 1447 patients were included, with a minimum follow-up period of 12 months. At final follow-up, both implants demonstrated significant improvements in comparison to preoperative baseline. On comparison of the inlay vs. onlay groups, the American Shoulder and Elbow Surgeons score was higher in the inlay group (mean difference, 2.53 [95% confidence interval, 0.27-4.78]; P=.03). Postoperative motion, even if statistically greater in the onlay group (differences of 5° in forward flexion [P<.001], 3° in abduction [P=.003], and 4° in external rotation [P<.001]), was not clinically different. On comparison of complications, the inlay group showed more instances of scapular notching (93 of 322 patients vs. 70 of 415 patients; odds ratio, 0.35; P<.001) but fewer scapular spine fractures (26 of 727 patients vs. 21 of 559 patients, P=.09). Inlay and onlay humeral tray designs in reverse total shoulder arthroplasty demonstrate similar clinical improvements postoperatively. Onlay implants have a low rate of scapular notching but a higher rate of scapular spine fracture. Understanding the strengths and weaknesses of the 2 humeral tray designs is important to provide surgeons with options to tailor surgical plans for high-risk patients.

Comparative study between sublay (retrorectus) and onlay mesh placement in ventral hernia repair at a teaching hospital

Background: Anterior abdominal wall defects give rise to ventral hernias. Treatment modalities vary from surgical options such as open procedure, laparoscopic method to further advanced robotic surgeries. The present study aimed to find the comparison between the postoperative and short term outcomes of onlay and retrorectus (sublay) mesh placements as ventral hernia repair methods. Materials and Methods: Our enrolled ventral hernia patients were divided into two groups of 20 each. Group A underwent traditional open onlay mesh repair and group B had open sublay/retrorectus mesh hernia repair. Age, gender, body mass index, comorbidities, and past surgical history, among both groups, were comparable. Results: The duration of surgery was significantly shorter in onlay group. The sublay group was related to fewer postsurgical complications and shorter duration of drain insertion. The duration of hospital stay had no statistical significance. Conclusion: Both techniques have their pros and cons and further research is required to determine a superlative.