Sublay versus Onlay Mesh Repair in Incisional Hernia: A Comparative Analysis.
Keywords:
Incisional hernia, mesh repair, sublay, retrorectus, onlay, postoperative pain, randomized controlled trial.Abstract
Background: Incisional hernia is a common complication following abdominal surgery, and mesh reinforcement has become the standard of care. This study aimed to compare the clinical outcomes of sublay versus onlay mesh repair in patients with incisional hernia.
Methods: This prospective randomized controlled clinical trial was conducted at the General Surgery Department, Faculty of Medicine, ….. Hospitals. A total of 60 patients diagnosed with incisional hernia and scheduled for elective surgical repair were recruited from general surgery outpatient clinics and the emergency department. Patients were randomly assigned into two equal groups: Group A (Onlay Group, n=30) underwent onlay mesh repair, and Group B (Sublay Group, n=30) underwent sublay (retrorectus) mesh repair. Baseline demographic, clinical, laboratory, and radiological characteristics were recorded. Operative parameters, postoperative pain scores (Visual Analogue Scale), hospital stay, return to normal activity, postoperative complications (seroma, hematoma, surgical site infection), and hernia recurrence at 12 months were compared between the two groups.
Results: Operative time was significantly shorter in the onlay group (88.93 ± 7.93 minutes) compared to the sublay group (99.67 ± 7.74 minutes) (p < 0.001). Postoperative pain scores were significantly lower in the sublay group at day 1 (4.70 ± 0.76 vs. 6.10 ± 0.79), 1 week (2.39 ± 0.75 vs. 3.99 ± 0.82), 1 month (0.85 ± 0.74 vs. 2.41 ± 0.88), 3 months (0.30 ± 0.49 vs. 1.41 ± 0.86), 6 months (0.16 ± 0.36 vs. 1.02 ± 0.82), and 12 months (0.14 ± 0.48 vs. 0.82 ± 0.86) (p < 0.001 for all). Hospital stay was significantly shorter in the sublay group (3.47 ± 1.11 days vs. 4.40 ± 0.93 days, p < 0.001), and return to normal activity was significantly earlier (21.53 ± 3.41 days vs. 26.07 ± 4.73 days, p < 0.001). No significant difference was found in drain removal day (p = 0.257). Postoperative complications including seroma (10.0% vs. 23.3%, p = 0.299), hematoma (3.3% vs. 6.7%, p = 1.000), and surgical site infection (6.7% vs. 16.7%, p = 0.424) were directionally lower in the sublay group but did not reach statistical significance. Hernia recurrence at 12 months was 3.3% in the sublay group versus 10.0% in the onlay group (p = 0.612). All patients completed the 12-month follow-up.
Conclusion: Sublay (retrorectus) mesh repair offers significant clinical advantages over onlay mesh repair for incisional hernia, including superior postoperative pain control, shorter hospital stay, and earlier return to normal activity. Postoperative complications and recurrence showed consistent trends favoring sublay repair. These findings support sublay mesh repair as the preferred technique for elective incisional hernia repair in appropriately selected patients..
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