Open retromuscular mesh repair versus onlay technique of incisional hernia: A randomized controlled trial

Demetrashvili, Zaza; Pipia, Irakli; Loladze, David; Metreveli, Tamar; Ekaladze, Eka; Kenchadze, George; Khutsishvili, Kakhi

doi:10.1016/j.ijsu.2016.12.008

Cited by 35 publications

(31 citation statements)

References 23 publications

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“…Surgical site infection occurred significantly less often after sublay/retro-rectus repair (OR = 2.42; 95% CI [1.02–5.74]; p = 0.05) ( 25 ). The results of the meta-analysis were also confirmed by the three RCTs available in the meantime comparing sublay/retro-rectus vs. onlay incisional hernia repair ( 42 , 57 , 58 ) (Table 3 ). Here, too, significantly more wound complications as well as a trend toward higher recurrence rates were identified for onlay repair of incisional hernias.…”

Section: Resultsmentioning

confidence: 53%

What Is the Current Knowledge About Sublay/Retro-Rectus Repair of Incisional Hernias?

Köckerling

Schug-Paß

Scheuerlein³

2018

Front. Surg.

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Introduction: There continues to be very little agreement among experts on the precise treatment strategy for incisional hernias. That is the conclusion drawn from the very limited scientific evidence available on the repair of incisional hernias. The present review now aims to critically assess the data available on the sublay/retro-rectus technique for repair of incisional hernia. Materials and Methods:A systematic search of the literature was performed in May 2018 using Medline, PubMed, and the Cochrane Library. This article is based on 77 publications.Results: The number of available RCTs that permit evaluation of the role of the sublay/retro-rectus technique in the repair of only incisional hernia is very small. The existing data suggest that the sublay/retro-rectus technique has disadvantages compared with the laparoscopic IPOM technique for repair of incisional hernia, but in that respect has advantages over all other open techniques. However, the few existing studies provide only a limited level of evidence for assessment purposes. Conclusion:Further RCTs based on a standardized technique are urgently needed for evaluation of the role of the sublay/retro-rectus incisional hernia repair technique.

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Section: Resultsmentioning

confidence: 53%

What Is the Current Knowledge About Sublay/Retro-Rectus Repair of Incisional Hernias?

Köckerling

Schug-Paß

Scheuerlein³

2018

Front. Surg.

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“…In the meantime, the findings of five RCTs reporting on the use of the onlay technique in incisional hernia repair are available (Table 1 ) ( 2 , 3 , 20 – 22 ). In all RCTs, defect closure was carried out as part of the onlay technique.…”

Section: Resultsmentioning

confidence: 99%

Onlay Technique in Incisional Hernia Repair—A Systematic Review

Köckerling

2018

Front. Surg.

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Introduction: A meta-analysis that compared the onlay vs. sublay technique in open incisional hernia repair identified better outcomes for the sublay operation. Nonetheless, an Expert Consensus Guided by Systematic Review found the onlay mesh location useful in certain settings. Therefore, all studies on the onlay technique were once again collated and analyzed.Materials and Methods: A systematic search of the available literature was performed in August 2018 using Medline, PubMed, Scopus, Embase, Springer Link, and the Cochrane Library. For the present analysis 42 publications were identified as relevant.Results: In five prospective randomized trials and 17 observational studies the postoperative complication rates ranged between 5 and 76%, with a mean value of 33.5%. The recurrence rates in these studies also ranged between 0 and 32%, with a mean value of 9.9%. Hence, compared with the literature data on the sublay operation, more post-operative complications, in particular wound complications and seroma, with a comparable recurrence rate, were identified.Conclusion: When the onlay technique is used in certain settings for incisional hernia repair, a careful dissection technique and prophylactic measures (drainage, abdominal binders, fibrin sealant) should be employed to prevent wound complications and seroma formation.

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“…These studies suggest that sublay or underlay IHR achieve a lower recurrence and complication rate than onlay IHR. [5][6][7][8][9][10][12][13][14][15][16] Some experimental studies have also studied this issue. Binnebosel et al 17 used an in vitro IH model and they found that sublay repair achieved more stability than onlay mesh repair.…”

Section: Discussionmentioning

confidence: 99%

“…The higher incidence of surgical site infection after onlay mesh IHR 7,9,10,13 could be explained because with this procedure the subcutaneous space is widely dissected and death space is created.…”

Section: Discussionmentioning

confidence: 99%

“…This technique avoids retromuscular and intrabdominal dissection that can provoke severe complications such as bowel injury, hematoma and adynamic ileus. The main complication after onlay IHR is surgical site infection 13 ; however, this complication is usually easy to treat and does not put the patient's life at risk. Another point that could encourage the choice of onlay IHR is the existence of multiple abdominal surgeries.…”

Section: Discussionmentioning

confidence: 99%

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Is Onlay Polypropylene Mesh Repair an Available Option for Incisional Hernia Repair? A Retrospective Cohort Study

Cano-Valderrama

Carro

Quirós

et al. 2019

The American Surgeon

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Lately, incisional hernia repair (IHR) with onlay polypropylene mesh has been replaced by other surgical procedures. The aim of this study was to compare the complication and recurrence rate after onlay mesh repair and other surgical procedures for IHR. A retrospective cohort study of patients who underwent IHR in a single center was conducted. The data were obtained from electronic medical records. Patients who had been lost during follow-up were contacted for a visit in the clinic. Univariate and multivariate analysis was performed with Stata 13.0 to analyze the factors associated with postoperative complications and hernia recurrence. Between June 2004 and December 2015, 1078 patients underwent IHR in a single center. Onlay mesh repair was performed in 125 patients (11.6%). Other surgical procedures included Rives procedure (29.3%), sublay mesh repair (38.6%), intrabdominal mesh repair (17.1%), and primary closure (3.4%). After a mean follow-up of 2.8 years, 73 (7%) patients developed a recurrence. A higher percentage of complications were seen after onlay mesh repair than after other surgical procedures (22.4% vs 13.1%, P = 0.005). Nevertheless, recurrence was less frequent after onlay mesh repair (4.2% vs 7.1%, P = 0.241). Logistic regression discarded an association between onlay mesh repair and hernia recurrence or postoperative complications. Incisional hernia repair with onlay polypropylene mesh repair was not associated with a higher incidence of postoperative complications or recurrence rate. So, this procedure should not be discarded in selected patients presenting with incisional hernia.

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Open retromuscular mesh repair versus onlay technique of incisional hernia: A randomized controlled trial

Cited by 35 publications

References 23 publications

What Is the Current Knowledge About Sublay/Retro-Rectus Repair of Incisional Hernias?

What Is the Current Knowledge About Sublay/Retro-Rectus Repair of Incisional Hernias?

Onlay Technique in Incisional Hernia Repair—A Systematic Review

Is Onlay Polypropylene Mesh Repair an Available Option for Incisional Hernia Repair? A Retrospective Cohort Study

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