Publication:

A comparative study between onlay and sublay mesh repair in the treatment of ventral hernias

Background Ventral hernias, characterized by a defect in the anterior abdominal wall fascia, are commonly managed surgically using mesh reinforcement. Among the widely adopted techniques, onlay and sublay mesh placements differ in anatomical location and complication profiles. Despite being routine procedures, consensus on the superior approach remains elusive. Objectives were to compare the clinical outcomes of onlay versus sublay mesh repair in patients undergoing elective ventral hernia surgery.

Methods This was a prospective interventional comparative study conducted at a tertiary care hospital from September 2019 to July 2021. A total of 90 patients were randomly allocated to undergo either onlay (n=45) or sublay (n=45) mesh repair. Parameters compared included duration of surgery, postoperative pain (VAS scores), incidence of early complications (surgical site infection, seroma, hematoma), duration of drain placement, hospital stay, and late complications (mesh infection, bowel obstruction, recurrence). Data were statistically analyzed for significance.

Results The mean duration of surgery was significantly longer in the sublay group, while the onlay group had a higher incidence of early postoperative complications including seroma and wound infections. The sublay group demonstrated significantly shorter postoperative hospital stay and fewer late complications.

Conclusions Although sublay mesh repair requires a longer operative time, it is associated with fewer complications, reduced postoperative morbidity, and quicker recovery. These findings support the adoption of sublay mesh placement as the preferred method in ventral hernia repair.