COMPARATIVE STUDY OF ONLAY VERSUS SUBLAY MESH REPAIR IN VENTRAL HERNIA: A RANDOMIZED CONTROLLED TRIAL.
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Keywords
Ventral hernia, Mesh repair, Onlay, Sublay, Randomized controlled trial.
Abstract
Background: Ventral hernia repair is one of the most frequently performed procedures in general surgery. While mesh reinforcement has reduced recurrence, the optimal plane of mesh placement is still debated. Onlay mesh repair is technically easier but carries higher risk of wound complications. Sublay repair, though technically demanding, is thought to reduce complications.
Objective: To compare clinical outcomes between onlay and sublay mesh repair in patients undergoing ventral hernia surgery.
Methods: In this randomized controlled trial, 60 patients with primary or incisional ventral hernia were randomized to undergo onlay (n=30) or sublay (n=30) mesh repair. Data collected included operative time, surgical site infection (SSI), seroma formation, drain duration, length of hospital stay, and recurrence. Statistical analysis was performed using SPSS v20.
Results: Sublay repair was associated with significantly fewer SSIs (10% vs 30%, p=0.04) and seromas (6.6% vs 26.6%, p=0.03). The mean hospital stay was significantly shorter in the sublay group (6.2 ± 1.1 vs 8.1 ± 1.3 days, p=0.001). Operative time was longer in sublay repair (92.3 ± 15.5 vs 86.7 ± 12.9 minutes, p=0.08), but the difference was not statistically significant. At 12-month follow-up, recurrence was comparable in both groups (one case each).
Conclusion: Sublay mesh repair results in fewer complications and shorter hospitalization compared to onlay repair, despite requiring slightly longer operative time. Sublay should be considered the preferred method in elective ventral hernia surgery.
References
2. Luijendijk RW, Hop WC, van den Tol MP, de Lange DC, Braaksma MM, IJzermans JN, et al. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med. 2000;343(6):392-8.
3. Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg. 2004;240(4):578-83.
4. Chevrel JP. The treatment of large midline incisional hernias by “overcoat” plastic repair with Dacron mesh. Chirurgie. 1979;105(6):419-22.
5. Mudge M, Hughes LE. Incisional hernia: a 10 year prospective study of incidence and attitudes. Br J Surg. 1985;72(1):70-1.
6. Rives J, Lardennois B, Pire JC, Hibon J. Les grandes éventrations. Chirurgie. 1973;99(7):547-63.
7. Schumpelick V, Klinge U, Junge K, Stumpf M. Incisional abdominal hernia: the open mesh repair. Langenbecks Arch Surg. 2004;389(1):1-5.
8. Bosi HR, Cavazzola LT, Cavazzola L. Onlay versus sublay technique for treatment of incisional hernia: a systematic review. Arq Bras Cir Dig. 2018;31(3):e1384.
9. Venclauskas L, Silanskaite J, Kanisauskas M, Kiudelis M. Long-term results of incisional hernia treatment: a comparative randomized study. Hernia. 2010;14(6):575- 82.
10. Saber A, Gad MA, Ellabban GM. Onlay versus sublay mesh repair for ventral hernia. J Surg. 2014;12(1):23-9.
11. Korenkov M, Paul A, Sauerland S, Neugebauer E, Arndt M, Chevrel JP, et al. Classification and surgical treatment of incisional hernia: results of an experts’ meeting. Langenbecks Arch Surg. 2001;386(1):65-73.
12. Kingsnorth AN, LeBlanc KA. Hernias: inguinal and incisional. 5th ed. London: Springer; 2013.
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Dr Santosh Kumar
Research Scholar Surgery, Index Medical College Hospital & Research Centre, Indore (Malwanchal University)
Dr (Prof) Rakesh Pancholi
Professor, Department of Surgery, Index Medical college Hospital & Research Centre, Indore (Malwanchal University)