Journal of Surgery
Volume 4, Issue 1-1, January 2016, Pages: 1-4
Received: Aug. 6, 2015;
Accepted: Aug. 7, 2015;
Published: Sep. 8, 2015
Views 7457 Downloads 244
Aly Saber, Port-Fouad General Hospital, Port-Fouad, Egypt
Emad K. Bayumi, General Surgery, Medical Academy Named After S.I. Georgiesky of Crimea Federal University, Crimea, Russia
Introduction: Ventral hernia repair is among the most common surgical operations performed worldwide and the two operative techniques most frequently used in case of ventral hernia are the onlay and sublay repair. However, it remains unclear which technique is superior. The aim of this study was to compare the outcome of the onlay versus sublay mesh repair for ventral hernia. Patients and Methods: A total of 200 patients with paraumbilical, epigastric and supraumbilical incisional hernias were divided into main two groups; A; onlay mesh repair and B; sublay mesh repair. End Points:The primary end point of the study was recurrence of the hernia, defined as a clinically detectable characteristic swelling and diagnosed by the two authors. The secondary end points were operative time, drainage time, seroma formation and purulent wound infection. Results: The mean operative time for onlay repair was 67.04 ± 13.19 minutes while in sublay group was 93.26 ± 24.94 minutes ranged from 60 to 140 minutes. As regard the drainage time, the mean total time in days was 7.47 ± 1.7 days in onlay repair while in sublay group was 4.5 ± 1.1 days. Seroma formation after suction drain removal was observed in 6% patients in group A and in 2% in group B. Purulent wound infection was observed in 8% and 4% patients in group A and B respectively treated with dressing and proper antibiotic according to culture tests. Disease recurrence was observed in 8 % and 3 % patients of group A and B respectively. Conclusion: Sublay mesh repair is a good alternative to onlay mesh repair that may be applicable to all forms of ventral hernia. The mesh related overall complication rate is low such as drainage time, seroma formation and wound infection as well as the low recurrence rate. The authors concluded for trials on sublay mesh repair with a large number of cases and a longer period of follow-up.
Emad K. Bayumi,
Onlay versus Sublay Mesh Repair for Ventral Hernia, Journal of Surgery. Special Issue: Abdominal Surgery: Toward the Best.
Vol. 4, No. 1-1,
2016, pp. 1-4.
Malik AM. Laparoscopic versus open repair of para-umbilical hernia. Is it a good alternative? J Pak Med Assoc.2015 ;65(8):865-868.
Gray SH, Hawn MT, Itani Kamal MF. Surgical progress in inguinal and ventral incisional hernia repair. SurgClin N Am 2008; 88: 17-26.
Forbes SS, Eskicioglu C, McLeod RS, Oakrainec A. Meta-analysis of randomized controlled trials comparing open and laparoscopic ventral and incisional hernia repair with mesh. Br J Surg 2009; 96: 851-8.
Timmermans L, de Goede B, van Dijk SM, Kleinrensink GJ, Jeekel J, Lange JF. Meta-analysis of sublay versus onlay mesh repair in incisional hernia surgery. Am J Surg. 2014 Jun;207(6):980-8.
Strâmbu V, Radu P, Brătucu M, Garofil D, Iorga C, Iorga R, Popa F. Rives technique, a gold standard for incisional hernias -- our experience. Chirurgia (Bucur). 2013 Jan-Feb;108(1):46-50.
Petro CC, Posielski NM, Raigani S, Criss CN, Orenstein SB, Novitsky YW. Risk factors for wound morbidity after open retromuscular (sublay) hernia repair. Surgery. 2015 Jun 20. pii: S0039-6060(15)00371-2. doi: 10.1016/j.surg.2015.05.003. [Epub ahead of print]
Hameed F, Ahmed B, Ahmed A, Dab RH, Dilawaiz. Incisional Hernia Repair by Preperitoneal (Sublay) Mesh Implantation. A P M C, 2009;3 (1): January-June27-31
Ibrahim AH, El-Gammal AS, Mohamed Heikal MM. Comparative study between 'onlay' and 'sublay' hernioplasty in the treatment of uncomplicated ventral hernia. Menoufia Med J 2015;28:11-6
Goda El-Santawy HM, El-Sisy AA, El-Gammal AS, El-Kased AF, Sultan HM. Evaluation of retromuscular mesh repair technique for treatment of ventral incisional hernia. Menoufia Med J 2014;27:226-9
Oh T, Hollands MJ, Langcake ME, Parasyn AD. Incisional hernia repair: a Retrospective review and early experience of laparoscopic repair. Surgery 2004; 74 :50-56.
Aoda FS and Ibrahim AS. Sublay versus onlay mesh repair of ventral hernia. QMJ, 2013; 9 (16):208-213
Ali Q. Murad F, Awan TA, Khan A, Malik AZ. Onlay Versus Sublay Technique of Repairing Ventral AbdominalHernia. JRMC; 2013;17(2):192-194
Martel g, Ahmad J, Taylo Mr. Novel treatment of refractory seroma after incisional hernia repair. Gut 2013;62:a19-a20 doi:10.1136/gutjnl-2013-305143.45
Haytham MA, K Hur, Hirter A, Kim LT, et al. Seroma in ventral incisional herniorrhaphy: incidence, predictors and outcome. Am J Surg 2009; 198 :639-644.
Jat MA, Memon MR, Rind GH. SQA Shah. Comparative evaluation of “Sublay” versus “Inlay” meshplasty in incisional and ventral hernias. Pak J Surg 2011; 27(1):54-58
LehrSC,and Schuricht AL. A Minimally Invasive Approach For Treating Postoperative Seromas After Incisional Hernia Repair. JSLS. 2001 Jul-Sep; 5(3): 267–271.
Saeed N, Iqbal SA, Shaikh BA, Baqai F. Comparison between onlay and sublay meth¬ods of mesh repair of incisional hernia. J Post Med Inst 2014; 28(4): 400-3.
Leithy M, Loulah M, Greida HA, Baker FA, Hayes AM. Sublay hernioplasty versus onlay hernioplasty in incisional hernia in diabetic patients. Menoufia Med J 2014;27:353-8
Milad NM, Said SM, Samir M. Comparison between onlay and retromuscular drainless mesh repair for para-umbil¬ical hernia with divarication of recti. Kasr El Aini J Surg 2009;10:11-6.
Albino FP, Patel KM, Nahabedian MY, Sosin M, Attinger CE, Bhanot P. Does mesh location matter in abdominal wall reconstruction? A systematic review of the literature and a summary of recommendations. Plast Reconstr Surg. 2013 Nov;132(5):1295-304.
MehmudAuranga 12.Korenkow M, Sauerland S, Arndt M, BogradL, Neugebauer EAM, Troidl H. Randomized Clinical trials of suture repair, polypropylene mesh or autodermal hernioplasty for incisional hernia. Br J Surg 2002; 89: 50-6.
Bauer JJ, Harris MT, Gorfine SR, Kreel I. Rives stoppa repair of giant incisional hernias. Experience with 57 patients. Hernia 2002; 6: 120-3. 6.
Kharde K, Dogra BB, Panchabhai S, Rana KV, Sridharan S, Kalyan S. A comparative study of onlay and retrorectus mesh placement in incisional hernia repair. Med J DY PatilUniv 2013;6:258-62
Elsesy A, Balba MA, Badr M, Latif MA. Retormascular preperitoneal versus traditional onlay mesh repair intreatment of incisional hernias. Menoufiya Med J 2008;21:209-20.
Gleysteen JJ. Mesh-reinforced ventral hernia repair: Preference for 2 techniques. Arch Surg 2009;144:740-5.