Onlay Versus Sublay Techniques for Incisional Hernia Repair: 30-Day Postoperative Outcomes

Abstract

BACKGROUND: The development of an incisional hernia is a common complication following laparotomy. It also has an important economic impact on healthcare systems and social security budget. The mesh reinforcement of the abdominal wall was an important advancement to increase the success of the repairs and reduce its long-term recurrence. The two most common locations for mesh placement in ventral hernia repairs include the premuscular (onlay technique) and retromuscular planes (sublay technique). However, until now, there is no consensus in the literature about the ideal location of the mesh. AIM: The aim of this study was to compare the two most common incisional hernia repair techniques (onlay and sublay) with regard to the complication rate within the first 30 days of postoperative care. METHOD: This study analyzes 115 patients who underwent either onlay or sublay incisional hernia repairs and evaluates the 30-day postoperative surgical site occurrences and hernia recurrence for each technique. RESULTS: We found no difference in the results between the groups, except in seroma formation, which was higher in patients submitted to the sublay technique, probably due to the lower rate of drain placement in this group. CONCLUSION: Both techniques of mesh placement seem to be adequate in the repair of incisional hernias, with no major difference in surgical site occurrences.

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

“…Demetrashvili et al 3 noted a lower rate of wound complications when comparing retromuscular hernia repair (22.1%) with onlay repair (50.0%) (p<0.001) 8 which corroborates the results of this study ( Table 3 ). Regarding the seroma rate being higher in the onlay group, even with the use of drain (p=0.00038), this finding corroborates a retrospective study by Hodgson et al who evaluated the occurrence of postoperative complications after drain placement in various types of hernia repair.…”

“…According to the literature, both seroma and infection are more frequent after the onlay technique due to the greater dissection of the subcutaneous tissue and its contact with the mesh 7 . However, recent meta-analyses comparing onlay and pre-peritoneal repair techniques showed no difference in seroma development, but fewer cases of wound infection were found in the pre-peritoneal group 8 .…”

“…Regarding the seroma rate being higher in the onlay group, even with the use of drain (p=0.00038), this finding corroborates a retrospective study by Hodgson et al who evaluated the occurrence of postoperative complications after drain placement in various types of hernia repair. They stated that drainage did not decrease the incidence of seroma formation but increased the length of stay of patients 8 . These results were also observed in this study.…”

Stapled Fascial Closure vs. Continuous Hand-Sewn Suture: Experimental Study of the Abdominal Wall on Porcine Model and Human Cadaver

“…Employing an appropriate technique for suturing the aponeurosis post-laparotomy is crucial for preventing the formation of incisional hernias 9 . Numerous techniques are available, differing in suture types, point distances, and the number of closure layers 20 . While mass closure has historically been the prevailing method for median incision closure, experimental studies advocating the small bite technique have significantly reduced incisional hernia rates 3 .…”