Onlay Versus Rives-Stoppa Techniques in the Treatment of Incisional Hernias

Abstract

BACKGROUND: In the surgical correction of large incisional hernias, the use of a prosthesis is essential in most cases regardless of the technique chosen. The preference is for the polypropylene prosthesis. AIMS: To compare the onlay and Rives-Stoppa techniques in the correction of incisional hernias, their immediate results, complications, advantages, and disadvantages. METHODS: Two groups of patients with incisional hernias were analyzed, submitted to the onlay (19 patients) and Rives-Stoppa (17 patients) techniques, and that used polypropylene prostheses. General epidemiological variables, perioperative data variables, and postoperative complications were assessed. RESULTS: The patients’ epidemiologic profile was similar between both groups. The majority were women (58.4%), with a mean age of 65.5 years and a previous mean body mass index of 41.5 kg/m². The Rives-Stoppa technique was employed in most patients (52.7%). Those submitted to the onlay technique had longer abdominal drainage time and longer hospital stay, as well as a higher incidence of seromas and surgical wound infection. CONCLUSIONS: The incisional herniorrhaphy technique with the placement of a pre-peritoneal polypropylene mesh by the Rives-Stoppa technique was superior to the onlay due to lower rates of drain use, hospital stay, and postoperative complications.

Comparative Analysis of Bilateral Open Inguinal Hernia Repair and Rives-Stoppa Repair: A Comprehensive Review

“…In direct comparisons between onlay and Rives-Stoppa techniques for incisional hernia repair, the Rives-Stoppa method has demonstrated superiority over onlay approaches due to lower rates of drain usage, shorter hospital stays, and fewer postoperative complications such as seromas and surgical wound infections [25].…”

“…The Rives-Stoppa repair technique presents several disadvantages, including its higher technical complexity, longer surgical duration, and the necessity for surgeons with extensive experience due to its intricacy [25]. In a comparative study assessing the onlay and Rives-Stoppa techniques for incisional hernia repair, it was noted that patients undergoing the onlay technique experienced prolonged abdominal drainage time, extended hospital stays, and a heightened incidence of seromas and surgical wound infections in comparison to those treated with the Rives-Stoppa technique [25].…”

“…The Rives-Stoppa repair technique presents several disadvantages, including its higher technical complexity, longer surgical duration, and the necessity for surgeons with extensive experience due to its intricacy [25]. In a comparative study assessing the onlay and Rives-Stoppa techniques for incisional hernia repair, it was noted that patients undergoing the onlay technique experienced prolonged abdominal drainage time, extended hospital stays, and a heightened incidence of seromas and surgical wound infections in comparison to those treated with the Rives-Stoppa technique [25]. Moreover, in the context of complex ventral incisional hernias treated with the Rives-Stoppa repair utilizing a Mersilene prosthesis, while the overall recurrence rate was low, there existed a risk of prosthetic infection necessitating mesh explantation, which could contribute to hernia recurrence [26].…”