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ONLAY VERSUS SUBLAY REPAIR AFTER INCISIONAL HERNIA: WHICH TECHNIQUE TO PREFER?
ONLAY VERSUS SUBLAY REPAIR AFTER INCISIONAL HERNIA: WHICH TECHNIQUE TO PREFER?
Mezjda Ismail Rashaan a
a Department of Surgery, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.
Submitted: 15/5/2020; Accepted: 30/6/2020; Published: 21/3/2021
DOI Link: https://doi.org/10.17656/jsmc.10290
ABSTRACT
Background
Incisional hernia (IH) is one of the most common complications worldwide after abdominal surgery. For repair of IH, a wide spectrum of surgical techniques is advocated. However, there is no consensus on the ideal technique for mesh location and it remains controversial.
Objectives
This clinical study aimed to compare the postoperative results of onlay mesh repair with sublay (retro-muscular) mesh repair.
Methods
This retrospective study was conducted in the surgical department of Sulaimani Teaching hospital from January 2010 to February 2014. Follow up period was for 2 years conducted via telephone or at outpatient clinics. All patients underwent preoperative evaluation and postoperative follow-up with regards to postoperative pain, wound infection, seroma, recurrence rates, and hospital stay.
Results
A total of 186 patients underwent open mesh repair for incisional hernia of whom 96 cases were operated on by onlay technique and 90 cases by sublay mesh repair. Patients who underwent onlay repair had statistically significant more post-operative complications compared to the sublay group 33 patients (34.4%) vs. 13 patients (14.4%), p< 0.001. In the onlay group, the incidence of recurrence was 13 (13.5%) compared with 3 (3.3%, p= 0.01) in the sublay group. 3 patients (3.3%) in the sublay group had wound infection compared with 10 patients (10.4%, p=0.05) in the onlay group. Patients in the onlay group had statistically significant more moderate pain (VAS 4-6) during hospital admission compared with the sublay group (82 (85.4%) vs. 62 (68.9%), p=0.01). However, patients in the sublay group had statistically more severe pain (VAS 7-10) during hospital admission compared to the onlay (28 (31.1%) vs. 14 (14.6%), p=0.01).
Conclusion
Sublay mesh repair is to be preferred to the onlay mesh repair technique because of the statistically significant less postoperative complications such as recurrence and wound infection.
KEYWORDS
Onlay Repair; Sublay Repair; Incisional Hernia.
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