A comparitive study of onlay vs sublay mesh repair in incisional hernias

Introduction: Incisional hernia after abdominal surgery is a well-known complication and the incidence of incisional hernias continues to be 2-11% after laparotomy. The repair of incisional hernia has always been a challenge to the surgeon .Various operative techniques for the repair of incisional hernia are in practice; however, the management is not standardized. The retro rectus mesh placement or the sub lay technique popularized by Rives and Stoppa in Europe, has been reported to be quite effective, with low recurrence rates (0-23%) and minimal complications.
Aims and Objective: The purpose of this study was to compare the traditional on lay mesh and retro rectus mesh placement in incisional hernia repairs in terms of time taken for surgery, early complications (wound infections, Mesh extrusion), and Delayed complications (Recurrence).
Materials and Methods: This is a prospective study which was conducted in the surgical department of our hospital. A total of 60 cases were included in this study. Of these cases, 30 cases were operated by the on lay mesh method and 30 by retro rectus mesh placement. Onlay the patients with midline hernias up to 10 cm in diameter were included in the study.
Result: The operative time for retro rectus mesh placement was insignificantly higher than that of onlay mesh repair, whereas, complications like superficial Surgical site infection SSI were identical in both the study groups, but deep SSI leading to infection of mesh was higher in onlay mesh repair. The recurrence is none
Conclusion: The best position for inserting the material has not been conclusively established. However in few studies it was found that ideal position for mesh repair appears to be retro muscular, where the force of abdominal pressure holds the prosthesis against deep surfaces of muscles .There is paucity of literature but an experimental study has also shown superiority of onlay technique based on different parameters.