Sublay Repair Research Articles

Examining Clinical Practice and Short-Term Results in Ventral Hernia Repair

Background and Objectives: This prospective observational study conducted at Parul Sevashram Hospital, Vadodara aimed to examine the diversity in surgical techniques used for primary and incisional ventral hernia repair (VHR). Methods: Twenty-five elective VHR patients treated from January 1, 2023, to March 31, 2023, were enrolled. Patients were monitored for 90 days post-surgery. Exclusion criteria included patients under 18 years old and those undergoing emergency surgeries. The primary objective was to compare surgical approaches between primary and incisional hernia repairs. Secondary objectives focused on intraoperative procedures such as mesh selection, fixation techniques, and drain placement, as well as evaluating postoperative outcomes at 3 months, including infection rates, surgical site issues, mortality, and readmission rates within 90 days. Results: Data from 25 patients were analysed: 14 (58%) had primary hernias (PH) and 11 (42%) had incisional hernias (IH), including 1 (9.09%) recurrent case. – PH Group: Procedures included 6 (42.85%) open Onlay, 4 (28.57%) open Sublay, 1 (7.14%) intraperitoneal Onlay meshplasty (IPOM), and 3 (21.42%) suture repairs. Complications: 7% seroma, 0% surgical site infection (SSI), 0% recurrence. – IH Group: Procedures included 7 (63.63%) open Onlay, 3 (27.3%) open Sublay, and 1 (9.09%) suture repair. Complications: 9% seroma, 9% hematoma, 0% SSI, 9% wound sinus, 0% recurrence. Conclusion: Onlay meshplasty emerged as the predominant procedure for both primary and incisional hernias. However, open Sublay repair showed promising results with fewer seroma-related complications. Standardizing guidelines could optimize outcomes in VHR.

A Comparative Study in Elective Repair of Large Incisional Hernias Using On-Lay Mesh vs. Sub-Lay Mesh – A Meta-Analysis

Abstract Background Ventral abdominal wall incisional hernia is defined as a defect in the musculo-fascial layers of the abdominal wall in the region of postoperative scar. There is a slight increase in the incidence of incisional hernia in the female gender. The higher percentage of incisional hernia in females might be due to laxity of abdominal wall muscles after multiple pregnancies and also increased incidence of obesity in females. Objective To assess incisional hernia repair using two different techniques: on-lay mesh and sub- lay mesh, as regards operative time, postoperative recurrence, wound infection, seroma, hematoma and flap necrosis. Patients and Methods The Pubmed, web of science and Scopus were searched on 15 March, 2022. The keywords incisional hernia, sub-lay mesh on-lay mesh, retromuscular mesh, polypropylene. Results and Conclusion According to our results, there is a statistical difference between onlay and sublay regarding intra-operative time as sublay mesh is more time consuming. Regarding post- operative complications there is no statistical difference in recurrence, seroma, hematoma, flap necrosis and infection but there is a statistical difference regarding in hospital stay as patients with sublay repair stays less than onlay.

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.

A comparative study in elective repair of large incisional hernias using on-lay mesh vs. sub-lay mesh: a meta-analysis

Ventral abdominal wall incisional hernia is defined as a defect in the musculo-fascial layers of the abdominal wall in the region of the postoperative scar. There is a slight increase in the incidence of incisional hernia in the female gender. The higher percentage of incisional hernia in females might be due to laxity of abdominal wall muscles after multiple pregnancies and also an increased incidence of obesity in females. To assess incisional hernia repair using two different techniques: on-lay mesh and sub-lay mesh, as regards operative time, postoperative recurrence, wound infection, seroma, hematoma, and flap necrosis. Pubmed, Web of Science, and Scopus were searched on 15 March 2022. The keywords incisional hernia, sub-lay mesh on-lay mesh, retromuscular mesh, and polypropylene. According to our results, there is a statistical difference between onlay and sublay regarding intra-operative time as sublay mesh is more time-consuming. Regarding postoperative complications, there is no statistical difference in recurrence, seroma, hematoma, flap necrosis, and infection but there is a statistical difference regarding in hospital stay as patients with sub-lay repair stays less than only.

Roboticassisted incisional hernia surgery-Retromuscular techniques

The trend to minimally invasive surgery has also made its way into the surgical treatment of incisional hernias. Unlike other areas of visceral surgery, recent years have seen aresurgence of open sublay repair in incisional hernia procedures, primarily due to the recognition of the retromuscular layer as the optimal mesh placement site. Additionally, with the growing availability of robotic systems in visceral surgery, these procedures are increasingly being offered in the form of minimally invasive procedures. These methods can be categorized based on the access routes: robotic-assisted transperitoneal procedures (e.g., r‑Rives, r‑TARUP, r‑TAR) and total extraperitoneal hernia repair (e.g., r‑eTEP, r‑eTAR). Notably, the introduction of transversus abdominis muscle release enables the robotic-assisted treatment of larger and more complex hernia cases with complete fascial closure. With respect to the comparison with open surgery required in retromuscular hernia treatment, the currently available literature on incisional hernia repair seems to show initial advantages of robotic-assisted surgery in the perioperative course. New technologies create new possibilities. In the context of surgical training the use of surgical robot systems with double consoles opens up completely new perspectives. Furthermore, the robot enables the implementation of models of artificial intelligence and augmented reality and could therefore open up novel dimensions in surgery.

Early Outcome after Sublay versus Onlay Polypropylene Mesh Repair for Ventral Midline Incisional Hernia - A Single Center Retrospective Analysis.

Onlay and retromuscular sublay mesh repairs are the most frequently used procedures in open repair of midline incisional hernias. The onlay placement of the mesh is simple and fast to perform, while the sublay retromuscular repair offers a supplementary protection against infection, but it is considered a more complicated procedure with a higher risk of early postoperative complications. The personal experience of the surgeons plays an important role in choosing the technique of mesh placement. This paper presents the results of a retrospective analysis of 220 consecutive patients operated on in the Surgical Clinic of the Mures Clinical County Hospital (Romania) between 31.01.2017 - 31.12.2019 with sublay or onlay polypropylene mesh repair for ventral midline incisional hernia. The patients were divided into two groups according to the position of the mesh. The two groups were identical in terms of age, sex distribution, incidence of comorbidities (obesity, diabetes mellitus, cardiac and respiratory diseases), number of previous operations and size of the defect (p value 0.05 for all the parameters). Results: Postoperative mortality was zero, with no statistically significant differences of the duration of the postoperative hospitalization between the two groups p 0.05. A total of 34 early reoperations were required for hematoma, skin necrosis, seroma, wound suppuration, and intestinal obstruction, with no statistically significant difference between the two groups (p 0.05 for the overall and separate incidence of each complication). The onlay placement of the mesh was associated with a later removal of the superficial drains p 0.0001 with a larger proportion of the patients who were discharged without removing the drains (group A 2/62 versus group B 141/168, p 0.0001). Conclusions: Both the onlay and the retromuscular sublay placement of polypropylene meshes may be used with good results for the treatment of midline incisional hernias. The lack of a supplementary early morbidity after the retromuscular sublay repair is an argument for a more frequent use of this technique which offers a supplementary protection against infection.

Retrospective analysis of 16 cases of lumbar hernia

BackgroundThrough a retrospective analysis of 16 cases of lumbar hernia, we discussed the anatomical basis, clinical manifestations, diagnosis, and treatment of this rare condition. MethodsWe collected medical data of 15 patients with a primary lumbar hernia and one patient with a secondary lumbar hernia treated in the General Surgery Department of Wuxi No.2 People's Hospital between January 2008 and June 2021 and analysed their demographic, preoperative, and postoperative data. ResultsAll patients underwent elective surgery performed by the same treatment team for superior lumbar hernias. The median area of the hernia defect was 12 cm2. Fifteen patients underwent sublay repair, and one underwent onlay repair. The median operative time and blood loss were 48 min and 22 mL, respectively. The hernia contents were extraperitoneal fat in 15 patients and partial small intestine in one. The median visual analogue scale score on postoperative day 1 was 3. A postoperative drainage tube was placed in three cases but not used in 13. The median duration of hospital stay was 5 days. Postoperative incision infection occurred in one case. During the follow-up period, no postoperative complications, including haematoma, seroma, incision infection or rupture, recurrence, and chronic pain, occurred in the other 15 cases. ConclusionLumbar hernias are rare and can be safely and effectively treated by open tension-free repair.

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.

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.

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.

Comparison of Sublay and Onlay Mesh Repair in Terms of Post-Operative Complications

Objective: To compare Sublay and Onlay mesh repair in terms of post-operative complications among patients undergoing hernioplasty.&#x0D; Study Design: Prospective comparative study.&#x0D; Place and Duration of Study: Surgical Department, Combined Military Hospital, Rawalpindi Pakistan, from Jan 2020 to Jun 2021.&#x0D; Methodology: This study was conducted on 300 patients who underwent hernioplasty for anterior abdominal wall hernias at our hospital. They were randomly divided into two groups before the surgery. Group-A received only mesh repair, while Group-B received subway repair. They were followed up for two weeks for any post-operative complications. Post-operative pain, seroma formation, hematoma formation and the presence of surgical site infection were compared in both groups.&#x0D; Results: Out of 300 patients included in the final analysis, 189(63%) were male, and 111(37%) were female. About 163(54.4%) underwent subway repair, while 137(45.6%) underwent only repair. The commonest complication observed in patients was post-operative pain 68(22.7%), followed by surgical site infection 36(12%). Statistical analysis revealed that seroma formation, post-operative pain and surgical site infection were significantly observed more in patients undergoing only mesh repair than subway repair (p-value&lt;0.05).&#x0D; Conclusion: Post-surgical complications were commonly observed in patients within two weeks of surgery. In addition, patients undergoing Onlay mesh repair were more prone to have seroma formation, post-operative pain and surgical site infection than those undergoing Sublay 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.

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.

Endoscopic Mini-or Less-Open Sublay Operation (E/MILOS) in ventral hernia repair: a minimally invasive alternative technique.

The ideal ventral hernia surgical repair is still in discussion1. The defect closure with a mesh-based repair is the base of surgical repair, in open or minimally invasive techniques2. The open methods lead to a higher surgical site infections incidence, meanwhile, the laparoscopic IPOM (intraperitoneal onlay mesh) increases the risk of intestinal lesions, adhesions, and bowel obstruction, in addition to requiring double mesh and fixation products which increase its costs and could worsen the post-operative pain3-5. The eTEP (extended/enhanced view totally intraperitoneal) technique has also arisen as a good option for this hernia repair. To avoid the disadvantages found in classic open and laparoscopic techniques, the MILOS (Endoscopically Assisted Mini or Less Open Sublay Repair) concept, created by W. Reinpold et al. in 2009, 3 years after eTEP conceptualization, allows the usage of bigger meshes through a small skin incision and laparoscopic retro-rectus space dissection, as the 2016 modification, avoiding an intraperitoneal mesh placement6,7. This new technique has been called E-MILOS (Endoscopic Mini or Less Open Sublay Repair)8. The aim of this paper is to report the E-MILOS techniques primary experience Brazil, in Santa Casa de Misericórdia de São Paulo.

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.

Endoscopic Mini/Less Open Sublay Repair for Two Large Abdominal Incisional Hernias in a Midline Wound and Stoma Closure Site

Endoscopic Mini/Less Open Sublay Repair for Two Large Abdominal Incisional Hernias in a Midline Wound and Stoma Closure Site

Endoscopic and endoscopically assisted mini or less open sublay mesh repair (EMILOS and MILOS) of abdominal wall hernias: Update and 10-year experience of a single insitution

Introduction: Abdominal wall hernia and incisional hernia repair are among the most frequent operations in general surgery. However, despite the use of mesh and other recent improvements, the open mesh techniques and laparoscopic IPOM repair have specific disadvantages and risks. Materials and Methods: To minimize complications of the existing open and laparoscopic techniques we developed the endoscopic Mini- or Less Open Sublay (EMILOS) and endoscopically assisted Mini- or Less Open Sublay (MILOS) concept. We report on our large series of minimally invasive sublay repair of and ventral incisional hernias. The operation is performed transhernially with light-holding laparoscopic instruments either under direct, or endoscopic visualization, while the abdominal wall is circumferentially elevated with retractors. An endoscopic light tube was developed to facilitate this approach (Endotorch,TM Wolf Company). Each MILOS operation can be converted to standard total extraperitoneal gas endoscopy (EMILOS repair) once an extraperitoneal space of at least 8 cm has been created. The technique allows minimal invasive repair of ventral hernias with concomitant rectus diastasis. In large eventrations E/MILOS m. transversus abdominis release (TAR) can be performed. All MILOS operations were prospectively documented in the German Hernia registry Herniamed. Technical modifications and improvements from the inception of the E/MILOS concept including variants of the EMILOS technique are addressed. Results: The total and surgical complication rates of 1745 E/MILOS incisional hernia operations were 4.6% and 3.1%, respectively. The reoperation rate was 1.7%. Haemorrhage, seroma, enterotomy, infection and bowel obstruction were detected in 1.0, 0.9, 0.2, 0.3 and 0.4 percent of the cases, respectively. The recurrence rate after one year was 1.2%. Chronic pain at rest, at activities and chronic pain requiring therapy was reported in 3.8, 7.4 and 3.6 percent, respectively. Conclusion: The MILOS technique allows minimally invasive transhernial repair of incisional hernias using large retromuscular / preperitoneal meshes with low morbidity. The technique is reproducible, cost effective, easy to standardize and combines the advantages of open sublay and the laparoscopic IPOM repair.

Preperitoneal space, is it an ideal layer for endoscopic sublay repair of ventral hernia?

Preperitoneal space, is it an ideal layer for endoscopic sublay repair of ventral hernia?

OV06 EXTENDING THE INDICATIONS OF TRANSVERSUS ABDOMINIS RELEASE: SUBLAY MESH REPAIR FOR A RARE CASE OF ACQUIRED DIAPHRAGMATIC HERNIA

Abstract Aim Acquired diaphragmatic hernia (ADH) is rare and its treatment is challenging. Posterior component separation (PCS) with transversus abdominis release (TAR) is gaining wide acceptance for the repair of complex abdominal hernia, including those located in proximity of the abdominal borders. In this view the central tendon of the diaphragm could be intended as the rooftop border of the peritoneal sac. We describe an original application of TAR for the treatment of an unusual case of ADH. Material and Methods a 54 year-old man was referred to our department for an ADH, following two previous sternotomies for an aortic aneurysm, conditioning respiratory symptoms. A thoraco-abdominal contrast enhanced CT-scan confirmed an anterior left diaphragmatic defect with a transverse diameter of 8.5 cm and a huge sac containing the great omentum and the distal transverse colon, with atelectasis of the inferior lobe of the lung. A subxiphoid M1W2L2 incisional hernia was also detected. The patient underwent a midline xipho-umbilical laparotomy and a repair by partial TAR with posterior rectus sheath release and progressive dissection of the diaphragmatic muscular fibers far beyond the DH. A sublay repair with a large dual layer PVDF mesh was then accomplished. Results Postoperative course was uneventful and no recurrence was recorded at 6 months follow up. Conclusions partial-TAR could be a good option for repair of anteriorly placed ADH, ensuring a stable anatomical repair with an overlap that is usually wider than after laparoscopic IPOM repair. This novel indication confirms the extreme versatility of TAR for the repair of complex ventral hernia

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.