Comparative analysis of onlay and sublay (retrorectus) mesh repair for incisional hernia (width ≤10 cm) of abdominal wall: A single-center experience

Background: Incisional hernia repair is one of the most common procedures performed in general surgery. Onlay and sublay mesh repair both are well established techniques for the locations of mesh placement, but with various benefits and drawbacks. Despite various studies, the debate continues regarding preferring one technique over the other. We aim to compare the outcome of hernia repair between these two techniques. Materials and Methods: Retrospective analysis was done on patients who underwent open onlay/sublay hernia repair from February 2018 to March 2020 at our institute. 9-28 months of follow-up was done. Primary outcome was recurrence. Secondary outcomes included postoperative complications including surgical site infection, hematoma, seroma, wound dehiscence, peri-operative pain, persistent seroma, readmission after 30 days and chronic pain. Results: A total of 87 patients underwent open ventral hernia repair during the study period. Of which, 41 had onlay and 46 had sublay repair (SR). Recurrence occurred in five patients (12.2%) with onlay repair and two patients in sublay group (4.3%) after a follow-up duration of up to 28 months (P = 0.247). Wound complications were more common in onlay group (46.3%) than the sublay group (19.5%) (P = 0.008). The mean standard deviation intraoperative blood loss (mL) was significantly higher in sublay group (156 [96]) than onlay group (123 [110]) (P < 0.0001). The postoperative drain output and the duration of placement were both greater in the onlay group (P < 0.0001). The median (range) of hospital stay was significantly longer in the onlay group (5[3-10] days) than the sublay group (4[2-6] days) (P < 0.001). Conclusion: SR seems to be the better technique taking into account the overall morbidity, although the need for multi-centric trials with patient-centered outcomes should be highlighted to settle the debate.