Sublay Group Research Articles

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.

Robotic-assisted repair of incisional hernia—early experiences of a university robotic hernia program and comparison with open and minimally invasive sublay technique (eMILOS)

PurposeWith robotic surgical devices, an innovative tool has stepped into the arena of minimally invasive hernia surgery. It combines the advantages of open (low recurrence rates and ability to perform complex procedure such as transverse abdominis release) and laparoscopic surgery (low rate of wound and mesh infections, less pain). However, a superiority to standard minimally invasive procedures has not yet been proven. We present our first experiences of robotic mesh repair of incisional hernias and a comparison of our results with open and minimally invasive sublay techniques.MethodsA retrospective analysis of all patients who underwent robotic-assisted mesh repair (RAHR) for incisional hernia between April and November 2022 (RAHR group) and patients who underwent open sublay (Sublay group) or eMILOS hernia repair (eMILOS group) between January 2018 and November 2022 was carried out. Patients in the RAHR group were matched 1:2 to patients in the Sublay group by propensity score matching. Patient demographics, preoperative hernia characteristics and cause of hernia, intraoperative variables, and postoperative outcomes were evaluated. Furthermore, a subgroup analysis of only midline hernia was performed.ResultsA total of 21 patients received robotic-assisted incisional hernia repair. Procedures performed included robotic retro-muscular hernia repair (r-RMHR, 76%), with transverse abdominis release in 56% of the cases. In one patient, r-RHMR was combined with robotic inguinal hernia repair. Two patients (10%) were operated with total extraperitoneal technique (eTEP). Robotic-assisted transabdominal preperitoneal hernia repair (r-TAPP) was performed in three patients (14%).Median (range) operating time in the RAHR group was significantly longer than in the sublay and eMILOS group (291 (122–311) vs. 109.5 (48–270) min vs. 123 (100–192) min, respectively, p < 0.001). The meshes applied in the RAHR group were significantly compared to the sublay (mean (SD) 529 ± 311 cm2 vs. 356 ± 231, p = 0.037), but without a difference compared to the eMILOS group (mean (SD) 596 ± 266 cm2). Median (range) length of hospital stay in the RAHR group was significantly shorter compared to the Sublay group (3 (2–7) vs. 5 (1–9) days, p = 0.032), but not significantly different to the eMILOS group. In short term follow-up, no hernia recurrence was observed in the RAHR and eMILOS group, with 9% in the Sublay group. The subgroup analysis of midline hernia revealed very similar results.ConclusionOur data show a promising outcome after robotic-assisted incisional hernia repair, but no superiority compared to the eMILOS technique. However, RAHR is a promising technique especially for complex hernia in patients with relevant risk factors, especially immunosuppression. Longer follow-up times are needed to accurately assess recurrence rates, and large prospective trials are needed to show superiority of robotic compared to standard open and minimally invasive hernia repair.

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.

Outcomes of recurrent incisional hernia repair by open and laparoscopic approaches: a propensity score-matched comparison.

Recurrent incisional hernias are challenging, and their surgical outcomes have not been well studied. We aimed to analyze the outcomes of recurrent incisional hernia repair in a propensity score-matched cohort study on laparoscopic intra-peritoneal onlay mesh repair (lap. IPOM) versus open sublay repair. All consecutive patients who had undergone open sublay repair and lap. IPOM of recurrent incisional hernia between January 2015 and December 2021 at a tertiary hernia center was identified. One-to-one propensity score matching was used to achieve a balanced exposure groups at baseline. Of 255 patients, 85/95 with open sublay repair were matched to 85/160 with lap. IPOM. Before matching, the open sublay group had significantly larger hernia defects (6.3cm vs. 5.0cm) than the lap. IPOM group. Other major baseline imbalances were also found in body mass index (BMI), obesity and European Hernia Society (EHS) width classification. The pre-match results showed that the lap. IPOM group had significantly shorter operative time (median 75 vs. 95min) and shorter postoperative hospital stay (median 8 vs. 11days) compared with the open sublay group. Wound infection (8.4% vs. 1.9%) and hematoma (5.3% vs. 0.6%) occurred more frequently after open sublay repair. After matching, baseline characteristics were well balanced. The recurrence rate and incidence of complications were comparable between the two groups. However, the post-match analysis still showed that lap. IPOM was associated with decreased length of postoperative stay. The outcomes of recurrent incisional hernia surgery after lap. IPOM and open sublay repair appear similar, except that the former had shorter length of postoperative stay. However, the poor outcomes were more likely associated with the unfavorable risk profiles, such as larger defect size, rather than the procedure technique itself.

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;

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

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

Open Retromuscular Sublay Mesh Repair Versus Laparoscopic Intraperitoneal Onlay Mesh Repair for Ventral Hernias-A Randomized Control Trial

Background: The precise treatment of ventral hernias is still a topic of considerable debate. The aim of this study was to compare the methods of open retromuscular sublay versus laparoscopic intraperitoneal onlay mesh repair for ventral hernias. Methods: Following approval by the Institutional Ethics Committee, Rohilkhand Medical College and Hospital, Bareilly, 88 patients were randomly divided into two groups in 1:1 allocation ratio, each compromising 44 patients. Patients characteristics, hernia size and postoperative complications were recorded. Results: Mean operative time was significantly (p= &lt;0.001) lower in the SUBLAY group (55.66±8.34 minutes) than in the IPOM group (68.75±10.44 minutes). The post-operative pain(VAS) was significantly (p=0.001) lower amongst patients of the IPOM group (2.36±0.61) as compared to the sublay (4.52±0.66) group. The hospital stay was significantly (p=0.001) lower among patients of the IPOM group (3.61±2.28 days) than the sublay group (6.50±1.68 days). Conclusion: Laparoscopic repair in medium- and large-sized defects is a feasible and safe approach. IPOM compared to SUBLAY significantly reduces postoperative complications and hospital stay.

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.

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.

Comparative study between the sublay versus onlay techniques of mesh hernioplasty in case of ventral hernias

Background: Abdominal hernias are common surgical conditions that can be presented as emergency and elective surgeries. Ventral hernia repair has always been a major challenge for surgeons. The mesh hernioplasty method has been considered the golden option for preventing or minimizing the incidence of recurrence, but the question is where surgeons should place the mesh or onlay. Objective: To compare the onlay versus sublay technique for ventral hernia in terms of performance and outcome. Methodology: Prospective study (120) of patients undergoing ventral hernia repair. We collect our cases for three years from (May 1, 2017 to May 2020) and will continue until (January 2022). Sixty patients were treated with onlay mesh repair (group A) and 60 patients were treated with underlay mesh repair (group B). Data collected in both groups were performed with respect to operative time, placement, and time required for drain removal, wound infection, and recurrence rate. Follow-up was performed every three months for 24 months. Data were analyzed using SPSS version 18, Fisher's exact test as appropriate; a p-value less than 0.05 was considered statistically significant.Results: In the sublay group, seroma formation was found in two patients (3.33%), while in 12 (20%) in the onlay group. Wound infection was found in one patient (1.66%) in the sublay group and 6 (10%) in the onlay group. no septic mesh was removed in the sublayer group, one mesh was removed in the onley type. In the onlay group, recurrence was found in 4 patients (6.66%), while no recurrence occurred in the sublay group. Conclusion: Sublay mesh hernioplasty is a better alternative to onlay mesh hernioplasty for all forms of ventral hernias.

Sublay mesh versus Onlay mesh: a randomized comparative study

Introduction. Ventral hernias are the second most common hernia; Onlay and Sublay operating techniques are procedures commonly performed in such cases. There is no consensus on the superiority of these procedures. The aim of this study was to compare the results of both procedures in order to identify the recommended technique between the two options. Materials and Methods. A total of 106 patients with epigastric, umbilical, paraumbilical, incisional hernias were studied. These patients were grouped into group A (onlay) and Group B (sublay). The outcomes of the two techniques were compared with respect to operative time, pain, hospital stay, seroma, infection, recurrence and patient satisfaction. Results. The mean operative time was 81.30 minutes in group A, and 85.85minutes in group B. Twenty-two (42.5%) patients in group A and seven (12.96%) patients in group B developed seroma. Nine (17.3%) patients in group A, 3 (5.55%) patients in group B developed post-operative infection. 30 (57.69%) patients in group A and 47(87.3%) patients in group B reported moderate pain, whereas three (5.76 %) and seven (12.96%) patients in group A and group B were reported severe pain in immediate post-operative period. At 48 hours, 20 (38.46%) and 24 (44.44%) of patients in group A and B were reported moderate pain, whereas 32 (61.53%) and 30 (55.55%) patients in group A and B reported mild pain. The mean hospital stay was 10.11 days in group A and 6.22 in group B. Three (5.76 %) patients of group A has recurrence, none of the patients in sublay group has developed recurrence. Thirty-nine (72.22%) patients of sublay group expressed their satisfaction but only 20(38.46%) patients in onlay group expressed their satisfaction. Conclusion. With reference to all the study parameters except one, the sub lay technique of mesh placement appears to be better. The exception is pain in the immediate postoperative period.

Comparative analysis of onlay and sublay (retrorectus) mesh repair for incisional hernia (width ≤10 cm) of abdominal wall

Background: Incisional hernia repair is one of the most common procedures performed in general surgery. Onlay and sublay mesh repair both are well established techniques for the locations of mesh placement, but with various benefits and drawbacks. Despite various studies, the debate continues regarding preferring one technique over the other. We aim to compare the outcome of hernia repair between these two techniques. Materials and Methods: Retrospective analysis was done on patients who underwent open onlay/sublay hernia repair from February 2018 to March 2020 at our institute. 9–28 months of follow-up was done. Primary outcome was recurrence. Secondary outcomes included postoperative complications including surgical site infection, hematoma, seroma, wound dehiscence, peri-operative pain, persistent seroma, readmission after 30 days and chronic pain. Results: A total of 87 patients underwent open ventral hernia repair during the study period. Of which, 41 had onlay and 46 had sublay repair (SR). Recurrence occurred in five patients (12.2%) with onlay repair and two patients in sublay group (4.3%) after a follow-up duration of up to 28 months (P = 0.247). Wound complications were more common in onlay group (46.3%) than the sublay group (19.5%) (P = 0.008). The mean standard deviation intraoperative blood loss (mL) was significantly higher in sublay group (156 [96]) than onlay group (123 [110]) (P &lt; 0.0001). The postoperative drain output and the duration of placement were both greater in the onlay group (P &lt; 0.0001). The median (range) of hospital stay was significantly longer in the onlay group (5[3–10] days) than the sublay group (4[2–6] days) (P &lt; 0.001). Conclusion: SR seems to be the better technique taking into account the overall morbidity, although the need for multi-centric trials with patient-centered outcomes should be highlighted to settle the debate.

Comparison of Post-Operative Complications Between Sublay and Onlay Mesh Repair in Incisional Hernia

Objective: To compare the post-operative complications between sublay and onlay mesh repair in incisional hernia. Materials &amp; Methods: This randomized controlled trial was conducted at Department of Surgery, Sandeman Provincial Hospital Quetta from May 2019 to November 2019. Total 250 patients with incisional hernias for more than 3 months, having age 20-40 years either male or female were selected. Then selected patients were placed randomly into two groups i.e. Group A (Sublay group) &amp; Group B (Onlay group), by using lottery method. Patients were called for follow up 15th day for post-operative complications in term of wound infection and seroma formation. Results: The mean age of patients in group A was 34.73 ± 4.32 years and in group B was 34.51 ± 4.67 years. Out of these 250 patients, 161 (64.40%) were female and 89 (35.60%) were males with female to male ratio of 1.8:1. Wound infection was seen in 07 (5.60%) patients in group A (Sublay technique) and 17 (13.60%) patients in group B (Onlay technique) with p-value of 0.033. Seroma formation was seen in 09 (7.20%) patients in group A (Sublay technique) and 26 (20.80%) patients in group B (Onlay technique) with p-value of 0.002. Conclusion: This study concluded that rate of wound infection and seroma formation is less after sublay mesh repair for incisional hernia as compared to onlay repair. Keywords: Hernia, incisional, onlay, sublay, seroma.

O26 INFECTIOUS COMPLICATION IN RELATION TO THE PROPHYLACTIC MESH POSITION: THE PRIMA TRIAL REVISITED

Abstract Aim Prophylactic mesh reinforcement has proven to reduce the incidence of incisional hernia (IH). Fear of infectious complications may withhold the widespread implementation of prophylactic mesh reinforcement, particularly in the onlay position. Material and Methods Patients scheduled for elective midline surgery were randomly assigned to a suture closure group, onlay mesh group, or sublay mesh group. The incidence, treatment, and outcomes of patients with infectious complications were assessed through examining the adverse event forms. Data were collected prospectively for 2 years after the index procedure. Results Overall, infectious complications occurred in 14/107 (13.3%) patients in the suture group and in 52/373 (13.9%) patients with prophylactic mesh reinforcement (p = 0.821). Infectious complications occurred in 17.6% of the onlay group and 10.3% of the sublay group (p = 0.042). Excluding anastomotic leakage as a cause, these incidences were 16% (onlay) and 9.7% (sublay), p = 0.073. The mesh could remain in-situ in 40/52 (77%) patients with an infectious complication. The 2-year IH incidence after onlay mesh reinforcement was 10 in 33 (30.3%) with infectious complications and 15 in 140 (9.7%) without infectious complications (p = 0.003). This difference was not statistically significant for the sublay group. Conclusions Prophylactic mesh placement was not associated with increased incidence, severity, or need for invasive treatment of infectious complications compared with suture closure. Patients with onlay mesh reinforcement and an infectious complication had a significantly higher risk of developing an incisional hernia, compared with those in the sublay group.

Onlay and sublay mesh repair in incisional hernias: our experience from GSL medical college and hospital, Rajahmundry

Background: The incidence of post-operative wound infection and wound-related complications due to mesh repair aimed at continuing research into the optimal method of treatment of these hernias. The two operative techniques most frequently used in case of ventral hernia are the onlay and sublay repair. However, it remains unclear which technique is superior. Objectives were to compare the morbidity and complications associated with onlay and sublay mesh repair in the management of incisional hernias.Methods: The present descriptive observational study was carried out in patients admitted in surgical wards at GSL medical college and hospital, Rajahmundry who are clinically diagnosed to have incisional hernia. The study was carried out from January to November 2019. Data was analysed with SPSS 23.0.Results: Seroma was seen in 12% and 8% respectively from onlay and sublay group and this proportion of seroma was more in onlay group as compared to sublay group (&lt;0.05). Postoperative recurrence of hernia was seen in both groups equally. Number of days of hospitalization in sublay group was less as compared to onlay group. Deep surgical site infection (SSI) was seen in 8% and 4% respectively from onlay and sublay group.Conclusions: Sublay mesh repair has a lower rate of post-operative complications than onlay mesh repair, deep SSI leading to infection of mesh is higher in on‑lay mesh repair. Number of days of hospitalization in sublay group was less as compared to onlay group.

Infectious Complication in Relation to the Prophylactic Mesh Position: The PRIMA Trial Revisited

Prophylactic mesh reinforcement has proven to reduce the incidence of incisional hernia (IH). Fear of infectious complications may withhold the widespread implementation of prophylactic mesh reinforcement, particularly in the onlay position. Patients scheduled for elective midline surgery were randomly assigned to a suture closure group, onlay mesh group, or sublay mesh group. The incidence, treatment, and outcomes of patients with infectious complications were assessed through examining the adverse event forms. Data were collected prospectively for 2 years after the index procedure. Overall, infectious complications occurred in 14/107 (13.3%) patients in the suture group and in 52/373 (13.9%) patients with prophylactic mesh reinforcement (p= 0.821). Infectious complications occurred in 17.6% of the onlay group and 10.3% of the sublay group (p= 0.042). Excluding anastomotic leakage as a cause, these incidences were 16% (onlay) and 9.7% (sublay), p= 0.073. The mesh could remain in-situ in 40/52 (77%) patients with an infectious complication. The 2-year IH incidence after onlay mesh reinforcement was 10 in 33 (30.3%) with infectious complications and 15 in 140 (9.7%) without infectious complications (p= 0.003). This difference was not statistically significant for the sublay group. Prophylactic mesh placement was not associated with increased incidence, severity, or need for invasive treatment of infectious complications compared with suture closure. Patients with onlay mesh reinforcement and an infectious complication had a significantly higher risk of developing an incisional hernia, compared with those in the sublay group.

Is Sublay Mesh Repair for Incisional Hernia Better Than Conventional Onlay Mesh Repair?

Background: Incisional hernia (IH) after abdominal surgery is a well-known complication and its incidence continues to be 10-15% after laparotomy. The repair of IH has always been a challenge to the surgeon. Various operative techniques for the repair of IH are in practice; however, the management is not standardized. The sublay technique has been reported to be quite effective, with low recurrence rates and minimal complications. Objective: To assess the advantage and complications of sublay mesh repair of IH in comparison to onlay mesh repair. Methods: Prospective study of 63 patients undergoing repair of IH from 1st January 2013 to 1st February 2015 done in General Surgical Unit of Al-Imamein Al-kadhmein Medical City. 42 cases of IH were managed by onlay mesh repair and 21 cases of IH were managed by sublay mesh repair. Results: Post-operative complications like seroma and wound infection were comparable in both groups. In sublay group seroma formation was one patient (4.76%). Wound infection was in one patient (4.76%). No septic mesh was removed in the series. In onlay group, seroma formation was in 9 patients (21.42%); most of seroma occur in large IH repair, wound infection was in 2 patients (4.76%) and one septic mesh was removed. In sublay recurrence rate was 0%, in onlay recurrence rate was in one patient (4.76%). Conclusion: Sublay mesh although it is more time consuming and technically more difficult, however, it carries low recurrence rate and few postoperative wound complication. Keywords: Sublay, onlay, Mesh Repair, Incisional Hernia Citation: Hasan YA, Al-Helfy SHA, Jabur RT. Is sublay mesh repair for incisional hernia better than conventional onlay mesh repair? Iraqi JMS. 2020; 18(2): 138-144. doi: 10.22578/IJMS.18.2.8.