Sublay Mesh Repair Research Articles

Comparison of Efficacy and Safety in Sublay versus Onlay Mesh Repair for Para-Umbilical Hernia: A Randomized Controlled Trial

Background: Ventral hernias, either spontaneous or post-surgical, represent a significant challenge in surgical practice. The recurrence rates after primary tissue repair, especially in larger hernias, necessitate the use of tension-free mesh repairs. However, the choice between onlay and sublay mesh repair methods remains a subject of debate, with each technique having its own set of advantages and drawbacks. Objective: The study aimed to compare the efficacy and safety of sublay versus onlay mesh repair techniques in the treatment of ventral hernias, with a focus on postoperative complications, pain, and treatment success rates. Methods: This randomized controlled trial was conducted from May 2023 to October 2023 at multiple surgical centers. It involved 120 patients, aged 18 to 70 years, undergoing ventral hernia repair. Patients were randomly allocated into two groups: Group A (60 patients) receiving onlay mesh repair and Group B (60 patients) receiving sublay mesh repair. The study assessed postoperative complications, including seroma, wound infection, and pain using the Visual Analogue Scale (VAS), as well as overall treatment efficacy. Data were analyzed using SPSS version 25.0, with a p-value of less than 0.05 considered statistically significant. Results: The mean age in Group A was 40.90±11.56 years, and in Group B, 40.55±11.63 years. Group A comprised 41.7% males and 58.3% females, while Group B had 46.7% males and 53.3% females. In Group A, seroma developed in 10%, wound infection in 15%, and postoperative pain in 18.3% of patients. Group B reported seroma in 3.3%, wound infection in 3.3%, and postoperative pain in 6.7%. The effectiveness of the treatment was 80% in Group A and 93.3% in Group B, with a notable difference in complication rates and success between the groups. Conclusion: The sublay mesh repair technique demonstrated superior outcomes in terms of lower complication rates and higher treatment efficacy compared to the onlay method. This suggests that the sublay approach may be more advantageous for ventral hernia repair, offering better patient outcomes with fewer postoperative complications.

A Comparative Study between Onlay versus Sublay Mesh Repair in Treatment of Midline Incisional Hernia

Abstract Background Incisional hernia is a common complication following laparotomy and is the most common indication for reoperation. However, the optimal approach for its repair is still a matter of debate. Aim of Study The aim of this study was to compare between onlay and sublay mesh repairs in treatment of midline incisional hernia regarding the operative technique and postoperative complications. Patients and Methods This randomized controlled prospective comparative study was conducted in general surgery department Ain-Shams University Hospital and Damanhour Medical National Institute in the period between November 2019 and April 2020. It included 40 patients with Midline incisional hernia who were randomly divided into two equal groups: A (treated with sublay repair) and B (treated with onblay repair). Results The mean operative time in group A was 104.2 minutes and in group B was 82.9 minutes. The mean time of drain removal in group A was 4.3 days while in group B was 13.6x days. Seroma formation after drain removal was not recorded in any patients of group A while it occurred in 4 patients in group B (20%). The other postoperative complications were comparable in both groups. During 6 months of follow up, hernia recurrence didn’t occurs in any patient in group A nor group B. Conclusion Sublay mesh repair of incisional hernia is a good alternative to onlay repair. It is applicable to all sites of incisional hernia with a low recurrence rate and acceptable complication rates.

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.

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.

Mini- or less-open sublay (E/MILOS) operation vs open sublay and laparoscopic IPOM repair for the treatment of incisional hernias: a registry-based propensity score matched analysis of the 5-year results.

Open sublay and laparoscopic IPOM repair have specific disadvantages and risks. In recent years, this evidence led to a paradigm shift and induced the development of new minimally invasive techniques of sublay mesh repair. Pioneering this trend, we developed the endoscopically assisted mini- or less-open sublay (MILOS) concept. The operation is performed trans-hernially via a small incision with light-holding laparoscopic instruments either under direct, or endoscopic visualization. After dissection of an extra-peritoneal space of at least 8cm, port placement and CO2 insufflation, each MILOS operation can be continued endoscopically (EMILOS repair). All E/MILOS operations were prospectively documented in the Herniamed Registry with 1- and 5-year questionnaire follow-ups. Propensity score matching of incisional hernia operations comparing the results of the E/MILOS operation with the laparoscopic intraperitoneal onlay mesh operation (IPOM) and open sublay repair from all other institutions participating in the Herniamed Registry was performed. The results with perioperative complications and 1-year follow-up have been published previously. This paper reports on the 5-year results. The 5-year follow-up rate was 87.5% (538 of 615 patients with E/MILOS incisional hernia operations). Comparing E/MILOS repair with laparoscopic IPOM and open sublay operation, propensity score matching analysis was possible with 448 and 520 pairs of operations, respectively. Compared with laparoscopic IPOM incisional hernia operation, the E/MILOS repair is associated with significantly fewer general complications (P = 0.004), recurrences (P < 0.001), less pain on exertion (P < 0.001), and less chronic pain requiring treatment (P = 0.016) and tends to result in fewer postoperative complications (P = 0.052), and less pain at rest (P = 0.053). Matched pair analysis with open sublay repair revealed significantly fewer general complications (P < 0.001), postoperative complications (P < 0.001), recurrences (P = 0.002), less pain at rest (P = 0.004), less pain on exertion (P < 0.001), and less chronic pain requiring treatment (P = 0.014). A limitation of this analysis is a relative low 5-year follow-up rate for laparoscopic IPOM and open sublay. The E/MILOS technique allows minimally invasive trans-hernial repair of incisional hernias using large standard meshes with low morbidity and good long-term results. The technique combines the advantages of sub-lay repair and a mini- or less-invasive approach. ClinicalTrials.gov Identifier NCT03133000.

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 of onlay versus sublay mesh repair in the management of ventral hernias.

Ventral hernias with large defects (≥ 2cm) are managed with tension free mesh repair. The growing consensus that sublay (retrorectus) mesh repair is superior to onlay mesh repair due to fewer complications is based on literature dominated by retrospective studies from high and upper-middle income countries. There is thus a need of more prospective studies from various countries to resolve the controversy. The objective of this study was to compare the outcomes of onlay versus sublay mesh repair in the management of ventral hernias. Our single centre, prospective comparative study set in a low-middle income country comprised of 60 patients with a ventral hernia undergoing open surgical repair using either onlay technique (n = 30) or sublay technique (n = 30). Surgical site infections, seroma formation, recurrence were found in 3.33%, 6.67%, 0% patients in sublay repair group and in 16.67%, 20%, 6.67% patients in onlay repair group respectively. Mean duration of surgery, mean Visual Analogue Scale (VAS) score for chronic pain, mean duration of hospital stay were 46min, 4.5, 8days in onlay repair group and 61min, 4.2, 6days in sublay repair group respectively. Onlay repair group was associated with shorter duration of surgery. However, sublay repair was associated with lesser rates of surgical site infections, chronic pain and recurrence than onlay repair. Sublay mesh repair had better outcomes than onlay mesh repair for the management of ventral hernias, however superiority of any one technique could not be established.

OC-029 E- MILOS EXTRAPERITONEAL MESH REPAIR OF UMBILICAL HERNIAS WITH COMBINED RECTUSDIASTASIS

Abstract Aim Umbilical hernias with combined rectusdiastasis have a higher risk für recurrence after single repair of the umbilical hernia. The E- MILOS concept enables the minimal invasive sublay mesh repair realizing the benefits of minimally invasive surgery and placing the mesh in the retromuscular position. Materials &amp; Methods All E- MILOS operations were documented prospectively. For 1 year follow-up all patients received a questionnaire. Results From January 2019 to December 2022, 89 patients (24 female/65 male) with umbilical hernia and a coexisting rectus diastasis (median hernia size 2 cm/diastasis recti 5,5 cm) and median age of 61 yrs were operated by 3 experienced surgeons. In all cases a polypropylene mesh (median size 40×12 cm) was implanted in the retromuscular space without any fixation and continuous suture (V-Loc 2–0) of the anterior and posterior rectus sheet was achieved for reconstructing the midline. The average skin incision was 4,5 cm; median operation time was 125 min. The median hospital stay was 5 days, the postoperative median pain score (VAS) was 2. Two patients needed reoperation due to a retromuscular haematoma. Chronic pain was reported by 13 patients, no postoperative infection and 4 recurrences were observed. Not satisfied with the cosmetic result (subcutaneous bulging) were 4 female patients. Conclusions The E- MILOS technique allows minimally invasive transhernial repair of umbilical hernias with combined rectusdiastasis using large retromuscular meshes with low morbidity. The technique is reliable and easy to standardize and shows mostly good cosmetic results.

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

TO STUDY DIFFERENT MODALITIES OF VENTRAL HERNIA REPAIR

Aim: To Study different modalities of ventral hernia repair . Study design- This is a retrospective observational study of patients treated at Tertiary health Care Centre, Pune. Type of study- Retrospective observational study. Period of studyJuly 2020 to July 2022. Sample size -Total 110 patients included in this study out of which 30 were treated laparoscopically ,30 ventral hernias were repaired by open sublay mesh repair ,50 ventral hernia repair was done by open onlay mesh repair surgery. Conclusion: Considering least post operative complication rates laparoscopic ventral hernia repair surgery is best inspite of its higher cost ..

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.

BJS-02 LONG-TERM REOPERATION RATE FOLLOWING PRIMARY VENTRAL HERNIA REPAIR: A REGISTER-BASED STUDY

Abstract Aim The aim of this study was to analyse the risk for reoperation following primary ventral hernia repair. Methods The study was based on umbilical hernia and epigastric hernia repairs registered in the population-based Swedish National Patient Register (NPR) 2010–2019. Reoperation was defined as repeat repair after primary repair. Results Altogether 30,253 umbilical hernia repairs and 7407 epigastric hernia repairs were identified. There were 624 reoperations registered following primary umbilical repair and 137 following primary epigastric repairs. In multivariable Cox proportional hazard analysis, the hazard ratio (HR) for reoperation was 0.284 (95% confidence interval (CI) 0.106–0.760) after open onlay mesh repair, 0.476 (CI 0.359–0.629) after open interstitial mesh repair, 0.368 (CI 0.230–0.590) after open sublay mesh repair, 0.446 (CI 0.167–1.194) after open intraperitoneal onlay mesh repair, 0.931 (CI 0.639–1.357) after laparoscopic repair, and 0.939 (CI 0.502–1.757) after other (unknown) techniques, when compared to open suture repair as reference method. Following umbilical hernia repair, the risk for reoperation was also significantly higher for patients aged ≤49 years (HR 1.669, CI 1.391–2.002), for women (HR 1.390, CI 1.178–1.641), and for patients with liver cirrhosis (HR 2.546, CI 1.050–6.174). For patients undergoing epigastric hernia repair, the only significant risk factor for reoperation was age ≤49 years (HR 2.079, CI 1.380–3.134). Conclusions All types of open mesh repair were associated with lower reoperation rates than open suture repair and laparoscopic repair. Female sex, young age and liver cirrhosis were risk factors for reoperation due to hernia recurrence, regardless of method.

TH1.11 Outcomes of Sublay Mesh repair in Ventral Abdominal hernia; retrospective study

Abstract Introduction Ventral hernia repair is one of the challenging surgical operations over time. It is suggested that sublay mesh repair has the lowest recurrence and surgical site infection in open anterior abdominal hernia repair. This study aimed to analyse the pros and cons of sublay mesh in ventral hernia repair to evaluate the significance of this technique as a treatment modality. Hospital stay, acute postoperative complications, and the recurrence rate were the main areas of investigation. Methods A retrospective study on 79 Patients with ventral hernias were operated on (electively) with sublay mesh repair over 3 years. Fit patients with first-time ventral hernias (primary and incisional) were included. Recurrent hernia, associated decompensated cardiopulmonary disorders, and bleeding disorders were excluded. The project Performa includes; patient's demographics, operative details, length of stay, postoperative complications, and follow-up, up to 12 months. Results All patients underwent open mesh repair using the sublay technique. Ventral hernia was five times more common in females than males. Mean age of presentation was at 44.8 years old. Mean operating time was 67 minutes and a 1-day hospital stay. Para-umbilical and incisional hernias represented the majority of cases. Component separation approach was added in three cases (3.7%). Simultaneous cholecystectomy was performed in 2 cases (2.5%). Only 6 cases (6.3%) developed wound-related complications, while 2 cases (2.5%) had a recurrence. Conclusion Sublay mesh repair is favourable for ventral abdominal hernia reconstruction. It is associated with a smooth and short hospital stay and the least incidence of complications and recurrence.

Long-term reoperation rate following primary ventral hernia repair: a register-based study

BackgroundThe aim of this study was to analyse the risk for reoperation following primary ventral hernia repair.MethodsThe study was based on umbilical hernia and epigastric hernia repairs registered in the population-based Swedish National Patient Register (NPR) 2010–2019. Reoperation was defined as repeat repair after primary repair.ResultsAltogether 29,360 umbilical hernia repairs and 6514 epigastric hernia repairs were identified. There were 624 reoperations registered following primary umbilical repair and 137 following primary epigastric repairs. In multivariable Cox proportional hazard analysis, the hazard ratio (HR) for reoperation was 0.292 (95% confidence interval (CI) 0.109–0.782) after open onlay mesh repair, 0.484 (CI 0.366–0.641) after open interstitial mesh repair, 0.382 (CI 0.238–0.613) after open sublay mesh repair, 0.453 (CI 0.169–1.212) after open intraperitoneal onlay mesh repair, 1.004 (CI 0.688–1.464) after laparoscopic repair, and 0.940 (CI 0.502–1.759) after other techniques, when compared to open suture repair as reference method. Following umbilical hernia repair, the risk for reoperation was also significantly higher for patients aged < 50 years (HR 1.669, CI 1.389–2.005), for women (HR 1.401, CI 1.186–1.655), and for patients with liver cirrhosis (HR 2.544, CI 1.049–6.170). For patients undergoing epigastric hernia repair, the only significant risk factor for reoperation was age < 50 years (HR 2.046, CI 1.337–3.130).ConclusionsAll types of open mesh repair were associated with lower reoperation rates than open suture repair and laparoscopic repair. Female sex, young age and liver cirrhosis were risk factors for reoperation due to hernia recurrence, regardless of method.

An Evaluation of the Evidence Guiding Adult Midline Ventral Hernia Repair.

Purpose: Several guidelines have been published in recent years to guide the clinician in ventral hernia repair. This review distils this advice, critically assesses their evidence base, and proposes avenues for future study. Methods: A PUBMED search identified four guidelines addressing midline ventral hernia repair published by major surgical societies between 2016 and 2020. The studies used to inform the advice have been critically appraised, including 20 systematic reviews/meta-analyses, 10 randomized controlled trials, 32 cohort studies, and 14 case series. Results: Despite a lack of randomized controlled trials, case heterogeneity, and variation in outcome reporting, key themes have emerged. Preoperative computed tomography scan assesses defect size, loss of domain, and the likely need for component separation. Prehabilitation, frailty assessment, and risk stratification are beneficial in complex cases. Minimally invasive component separation techniques, Botox injection, and progressive pneumoperitoneum represent novel techniques to promote closure of large fascial defects.Rives-Stoppa sublay mesh repair has become the “gold” standard for open and minimally invasive repairs. Laparoscopic repair promotes early return to functional status. The enhanced-view totally extraperitoneal approach facilitates laparoscopic sublay mesh placement, avoiding mesh contact with viscera. Robotic techniques continue to evolve, although the evidence at present remains immature.Synthetic mesh is recommended for use in clean and clean-contaminated cases. However, optimism regarding the use of biologic and biosynthetic meshes in the contaminated setting has waned.Conclusions: Surgical techniques in ventral hernia repair have advanced in recent years. High-quality data has struggled to keep pace; rigorous clinical trials are required to support the surgical innovation.

Comparative review of outcomes: single-incision laparoscopic total extra-peritoneal sub-lay (SIL-TES) mesh repair versus laparoscopic intraperitoneal onlay mesh (IPOM) repair for ventral hernia

To compare outcomes between single-incision laparoscopic totally extra-peritoneal sub-lay (SIL-TES) mesh repair and laparoscopic intraperitoneal onlay mesh (IPOM) repair of ventral hernia (VH). A retrospective selection of 104 patients who underwent VH repair (50 and 54 in the SIL-TES and IPOM groups, respectively) was made. Patient data were collected, and quality of life was evaluated using Carolinas Comfort Scale (CCS) 1 month and 3 months after surgery. There were no significant differences in sex, American Society of Anesthesiologists class, defect size, mesh area, estimated blood loss, and complication rate between the groups. Age was lower, body mass index was higher, prevalence of primary VH was significantly higher (p < 0.0001), and pain was less at 24 and 48 h post procedure (p < 0.0001) in the SIL-TES group. Drainage placement was more (p < 0.0001), operation time was shorter (p = 0.012), and hospitalization duration and total hospitalization cost were greater in the IPOM group than that in SIL-TES group (8.3 ± 0.3 vs 4.3 ± 0.4 days, p < 0.0001; $7126.9 ± 141.4 vs $2937.3 ± 58.3, p < 0.0001, respectively). Pain and movement limitation scores evaluated by CCS were significantly worse at 1 month (4.93 ± 0.28 vs 1.75 ± 0.28: p < 0.0001; 2.52 ± 0.24 vs 1.15 ± 0.18: p < 0.0001, respectively) and 3 months (4.32 ± 0.37 vs 0.9 ± 0.29: p < 0.0001; 2.06 ± 0.25 vs 0.69 ± 0.11: p < 0.0001, respectively) in IPOM group, compared with the according scores in SIL-TES group. There was no readmission within 30 days and no hernia recurrence at mean follow-up of 12 months. SIL-TES mesh repair is safe and effective and is superior to IPOM repair.

Sublay and overlay mesh repair in paraumbilical hernias– which surgery you will prefer??

Background: Paraumbilical hernia accounts for 33.9% of anterior abdominal wall hernia. Mesh can be applied onlay; on the anterior fascia, inlay; in the hernia defect, sublay; to retro-rectus or preperitoneal space or underlay; in the intraperitoneal position. Aims and Objectives: The objectives of the study are as follows:1) To compare the efficacy between sublay and onlay mesh repair for paraumbilical hernia. 2) To compare the safety between sublay and onlay mesh repair for paraumbilical hernia. Materials and Methods: A prospective study was conducted on 120 patients (60 in each group) patients. The patients were randomly allocated in two groups by lottery method. Patients in Group-A were subjected to sublay mesh repair procedure and patients in Group-B were subjected to onlay mesh repair procedure for paraumbilical hernia repair. Postoperatively, every patient was kept under observations for 3–4 days in ward and observed for complications. Postoperatively, all patients were followed at 10 days, 3 months, and 6thmonth to confirm efficacy and safety of the procedure. Results: The average age of Group-A was 39 years and 32 years in Group-B. In Group-A, 55% patients were female and 45% patients were male; whereas in Group-B, 60% patients were female and 40% patients were male. More over sublay mesh repair was effective in 82% patients on the bases of recurrence while this procedure was safe in 90% cases on the bases of complications whereas onlay mesh repair was effective in 90% patient’s cases on the bases of recurrence while this procedure was safe in 93% cases on the bases of complications. Conclusion: Onlay mesh repair technique is more effective, quick, and safe as compared to sublay mesh repair technique for the treatment of paraumbilical hernia.

A COMPARATIVE STUDY BETWEEN ONLAY AND SUBLAY MESH REPAIR IN THE MANAGEMENT OF INCISIONAL HERNIA

Background: An incisional hernia is one of the common complications of abdominal surgery and the incidence of incisional hernias continues to be 3 to 11% after laparotomy. The repair of incisional hernia has always been a challenge to the surgeon. Various operative techniques for the repair of incisional hernia are in practice; however, the management is not standardized. Aim: To compare onlay mesh placement versus sublay mesh placement in repair of incisional hernias. This prospective study Material and Methods: comprised of 50 patients with an incisional hernia. A total of 50 cases were included in the study. Of the 50 cases, 25 cases were operated by the onlay mesh method and 25 by sublay mesh placement. Results: The operative time for sublay mesh repair was signicantly higher than that of onlay mesh repair, whereas, complications like haemorrhage, seroma formation and deep surgical site infection leading to extrusion of mesh was higher in onlay mesh repair. The recurrence rate was found to be 4% in onlay mesh repair whereas it was 0% in sublay mesh repair. Sublay mesh repair, though technically difcult, Conclusion: and takes more time for surgery has the distinct advantage of reducing the rate of infection and recurrence.

Compare the Efficacy and Safety between Onlay Versus Sublay Mesh Repair for Para-Umbilical Hernia

Objective: To compare the efficacy and safety between onlay mesh technique and sublay mesh technique in patients undergoing paraumbilical hernia repair. Study Design: Retrospective/Observational Place &amp; Duration: In the department of surgery, Muhammad Teaching Hospital, Peshawar and Fauji Foundation Hospital, Rawalpindi and conducted during the period from March 2021 to August 2021. Methods: A total of 166 patients with both genders having ages 18 to 65 years who were undergoing para-umbilical hernia repair were included. Patients demographic including age, gender were recorded after informed consent. Patients were equally divided into two groups Group O and Group S. Group O (83 patients) received onlay mesh technique and Group S (83 patients) received sublay technique. Outcomes such as post-operative pain, wound infection, seroma formation and hospital stay were recorded and compare the results between both groups. Results: In group O 48 (57.83%) patients and in group S 47 (56.63%) patients were females while 35 (42.17%) and 36 (43.37%) patients were males in group O and S. There was significant difference in term of post-operative pain 6.01+2.26 vs 3.58+1.44 (P-value &lt;0.05). In group O 14 (16.87%) patients and in group S 4 (4.82%) patients had wound infection. 8 (9.64%) patients in Group O and 2 (2.40%) patients in Group S had seroma. Mean Hospital stay in days was high in Group O compared to Group B 5.32+1.74 vs 2.46+1.38 days (p=&lt;0.05). There was a statistical significant difference regarding efficacy between both procedures with p-value 0.036. Conclusion: We concluded that sublay mesh technique for para-umbilical hernia repair was safe and effective with very low rate of complications as compared to onlay mesh procedure. Keywords: Paraumbilical Hernia Repair, Onlay Mesh Technique, Sublay Mesh Technique, Outcomes.

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.