Randomized prospective comparison of long-term results of onlay and sublay mesh repair techniques for incisional hernia

Abstract

Objective: Incisional hernia is a significant problem after laparotomy, and there is still no consensus on an ideal treatment method. The aim of this study was to compare the results of onlay and sublay mesh repair techniques. Material and Methods:In this randomized prospective trial, 100 patients were divided into two groups: onlay and sublay groups. Recurrences were evaluated by performing a physical examination. Results:The median follow-up was 37.1 (26.6 to 46.5) months. In the onlay group, the mean operation time was significantly shorter. However, in terms of postoperative pain and wound complications, the sublay group had significantly better results. The recurrence rates were found to be similar in both groups (6% in the onlay group and 2% in the sublay group). Conclusion:In the treatment of incisional hernia, sublay mesh repair is superior to onlay mesh repair in terms of postoperative pain and wound complications. Both techniques have similar recurrence rates. Keywords:Incisional hernia, mesh repair, onlay, sublay INTRODUCTIONIncisional hernia is a significant complication after laparotomy; its incidence ranges between 10% and 20% (1-4). This common problem can result in bowel strangulation, pain, and enterocutaneous fistula, and it affects the quality of life. The results of repair techniques vary widely. High recurrence rates have been reported for suture techniques, whereas mesh placement can reduce recurrence (5-10). In mesh repair, one of the most important problems is the placement of the mesh. Some techniques are reported to be associated with particularly high rates of some complications, such as recurrence, wound infection, and fistula (11,12). In the literature, several studies compare mesh and suture repair techniques, open and laparoscopic repair techniques, and mesh type as well as the plane in which the mesh should be placed. Currently, there is no consensus regarding the abdominal plane in which the mesh should be placed (13).The aim of this study was to compare the early and late results of onlay and sublay mesh repair techniques. , an American Society of Anesthesiologists score (ASA) of 4, or severe pulmonary or cardiac disease were not included. The remaining patients who agreed to be involved and signed the informed consent form were randomized into two groups: onlay group and sublay group. After the initial evaluation, 100 patients were included and were randomized to each group by the closed envelope method. The patients' demographic data, BMI, diameter of fascial defects, operation time (from first incision to dressing), visual analog scale (VAS) scores at the second and 24 th hours, length of hospital stay, drain takeoff time, postoperative complications, and recurrences were recorded. The fascial defect diameter was measured intraoperatively and is presented in cm 2 . All operations were performed according to the elective standard. There were no emergency operations. MATERIAL AND METHODS Operative TechniqueAll operations were performed under general anesthesia, and no antibioti...

Comparative Study between Sublay versus Onlay Mesh Repair in Treatment of Incisional Hernia

“…In our study, the incidence of seroma formation after drain removal was significantly higher in the onlay group. This is consistent with the results of Sevinç et al, who reported seroma formation after drain removal in 14% of cases in the onlay group and in only 2% in the sublay group (p=0.027) [7] . Ahmed and Mehboob reported a higher incidence of seroma formation after drain removal but still much less in the sublay group than in the onlay group with statistically significant difference ( p= 0.001).…”

“…Sevinç et al, in 2018 reported that the drains were removed when the daily outcome was below 50ml. The mean drain removal time was 5.4 days in the onlay group and 3.2 days in the sublay group (p=0.001) [7] . This agrees with our results that there was a significant difference between the 2 groups regarding the time of drain removal but differs in that the drainage time was shorter than in our study especially in the onlay group.…”

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

“…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.…”

“…However, the open sublay/retro-rectus technique has been found to have advantages over the other incisional hernia open repair techniques ( 14 , 25 , 58 ). In comparison with the open suture technique, onlay and underlay or intraperitoneal onlay technique, consistently lower recurrence rates have been identified for the sublay/retro-rectus technique.…”

Landmarks in vaginal mesh development: polypropylene mesh for treatment of SUI and POP

“…2) . Onlay repairs involve extensive subcutaneous tissue dissection and a large area of the mesh implant stayed very close to skin, increasing the chances of wound complications such as infection and seroma formation 33 . To reduce complications a sublay (retrorectus) technique was then developed, in which the mesh is put underneath thick muscle tissue (retrorectus, Fig.…”