Meta-analysis of sublay versus onlay mesh repair in incisional hernia surgery

Timmermans, Lucas; Goede, Barry de; Dijk, Sven M. van; Kleinrensink, Gert-Jan; Jeekel, J.; Lange, Johan F.

doi:10.1016/j.amjsurg.2013.08.030

Cited by 140 publications

(97 citation statements)

References 22 publications

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“…8 The techniques of placements include onlay, sublay, sandwich technique, etc. 9 But the best position for inserting the mesh has not been conclusively established till date as per literature. 10 Although polypropylene mesh has long been regarded as the implant of choice for repairing abdominal wall defects, there is still controversy regarding the best site of its placement.…”

Section: Introductionmentioning

confidence: 99%

Onlay versus sublay mesh repair for ventral hernia

Muralidhar

Shetty

et al. 2018

Int Surg J

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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.Methods: A total of 100 patients with paraumbilical, epigastric, supraumbilical and incisional hernias (with defect size ≤4 inches) were divided into main two groups; A: onlay mesh repair and B: sublay mesh repair. Patients with uncontrolled diabetes and recurrent ventral hernia were excluded. Randomization was done using computer generated software. Patients were evaluated for operating time, postoperative seroma formation, wound infection, drain duration, post-op hospital stay and recurrence of symptoms. Ethical approval for this study was granted by the ethical review committee of Mysore Medical College, Mysore, Karnataka, India.Results: The incidence of post-operative seroma and wound infection was 6.52% and 4.35% in sublay group compared to 21.30% and 19.20% in onlay group which was statistically significant (p<0.05). Mean operating time was found to be more in sublay group than onlay group which was also statistically significant (72.3+9.23 vs. 65.25+10.58 minutes, p<0.05). Mean drainage duration (4.22+0.99 days vs. 5.97+1.24 days) and post-op hospital stay (4.8+1.51 days vs. 6.68+1.46 days) was low in sublay group compared to onlay group which was statistically significant (p<0.05). Recurrence in sublay group was 4.35% compared to 8.51% in onlay group which was not statistically significant (p>0.05).Conclusions: Even though operating time is longer, placement of mesh in sublay position is a better option than onlay placement in open ventral hernia repair because of lower complication rate and post-op morbidity.

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Section: Introductionmentioning

confidence: 99%

Onlay versus sublay mesh repair for ventral hernia

Muralidhar

Shetty

et al. 2018

Int Surg J

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“…Previous studies have shown that 70-75% of recurrences develop within 2 years and 80-90% develop within 3 years. 4,7,9 Our follow-up, therefore, is probably not long enough and should be extended for at least another year.…”

Section: Discussionmentioning

confidence: 99%

“…Analysis of various techniques of ventral hernia repair along multiple outcome variables reveals that mesh-based repair offers the best alternative when compared with the suture-based technique. [4][5][6][7][8] The main issue is increased risk for infection with the placement of a foreign body and the cost factor.…”

Section: Discussionmentioning

confidence: 99%

“…3 The history of prosthetic repair in abdominal wall hernias began in 1844 with the use of silver wire coils placed on the floor of the groin to induce an inflammatory fibrosis augmenting the repair .Many prosthetic materials have been tried in hernia repair, but the two most common in current use are polypropylene mesh and expanded polytetrafluoroethylene .The repair of ventral hernias varies from primary closure only, primary closure with relaxing incisions, primary closure with onlay mesh reinforcement, onlay mesh placement only, inlay mesh placement, and intraperitoneal mesh placement .Primary closure techniques are usually performed for small fascial defects less than 5 cm in greatest diameter. 4 Even for small hernia defects, recurrence rates in excess of 50% have been reported. An onlay, usually of polypropylene mesh, is sutured to the anterior rectus sheath after the fascial defect has been closed primarily.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of retro muscular mesh repair technique for treatment of ventral hernia

et al. 2018

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Ventral hernias commonly encountered in surgical practice account for 15-20% of all abdominal wall hernias. Results of tissue repair have been disappointing. The optimal approach for abdominal incisional hernias is still under discussion. The aim of the study was to evaluate the retro muscular mesh repair technique in the treatment of ventral hernia as one of the standard techniques for treatment of such cases. This prospective study on 50 consecutive patients was performed from July 2016 to July 2017. Patients were prepared to be operated by the retro muscular mesh repair technique. All patients were evaluated with respect to operative time and postoperative complications. Results were documented and statistically analysed. In this study on 50 patients, there were 30 female patients (60%) and 20 male patients (40%). The age of the studied patients ranged between 26 and 65 years with mean age of 49.8 years. The mean operative time was 88.5±15.3 min. The mean period of drainage was 2.3±1.3 days. Seroma was encountered in one case only 2%. No recurrence was reported in the studied patients during the period of follow-up (12months). On the basis of this study, we conclude that retro muscular (sublay) mesh repair is the ideal technique for incisional hernia repair.

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“…No single technique is suitable or feasible for all types of hernias and different methods of repair may be indicated for specific defects and locations. Nevertheless the sublay technique appears to be superior to other techniques particularly in difficult to treat wound beds (for example poorly vascularized or repeatedly operated wounds) [42,43]. …”

Section: Modifications To the Surgical Technique To Improve Outcomes mentioning

confidence: 99%

Synthetic Materials Used in the Surgical Treatment of Pelvic Organ Prolapse: Problems of Currently Used Material and Designing the Ideal Material

Mangır¹,

Chapple²,

MacNeil³

2018

Pelvic Floor Disorders

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Synthetic materials have long been used to provide structural support when surgically repairing pelvic organ prolapse (POP). The most widely used synthetic material is a mesh made of polypropylene (PPL). The use of mesh is intended to improve cure rates and prevent recurrences after POP surgery -however as more mesh materials have been implanted, it has become apparent that serious complications can occur in up to 30% of women, particularly when the mesh is implanted transvaginally. Over the years many different mesh kits have been marketed and used in the treatment of POP however polypropylene mesh was never designed or tested for use in pelvic floor. Instead it was approved for clinical use based on its biocompatibility and success in abdominal hernia repairs. It is now known that PPL meshes are neither compliant with the mechanical forces in the pelvic floor nor do they integrate well into paravaginal tissues. Better materials developed specifically for use in pelvic floor are urgently needed. The aim of this chapter is to define the requirements of an ideal mesh in terms of its material properties and to summarize the ongoing research on developing the next generation pelvic floor repair materials.

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Meta-analysis of sublay versus onlay mesh repair in incisional hernia surgery

Cited by 140 publications

References 22 publications

Onlay versus sublay mesh repair for ventral hernia

Onlay versus sublay mesh repair for ventral hernia

Evaluation of retro muscular mesh repair technique for treatment of ventral hernia

Synthetic Materials Used in the Surgical Treatment of Pelvic Organ Prolapse: Problems of Currently Used Material and Designing the Ideal Material

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