Open mesh repair, is still a standard technique for incisional hernia: a comparision study between sublay and onlay technique in the era of laparoscopy

Background: Incisional hernia (IH) remains a very frequent postoperative complication and common hernias in middle aged population more commonly in females. The two techniques most frequently used are the onlay repair and sublay repair. Various studies have been conducted to compare the advantages and disadvantages of sublay and onlay mesh repair in incisional hernia and the superiority of sublay mesh repair. These studies whether they hold good for the population is a pertinent question. In view of this, author need to study the appropriate surgical techniques sublay versus onlay repair in the set up.Methods: Author conducted randomized comparative study of 100 patients having incisional hernia admitted to various surgical units of SNMC and HSK Hospital, Bagalkot during the period December 2014 to June 2016.Results: In present study of 100 cases, females have more incidence of incisional hernias than males. In onlay technique seroma formation was found in 72% of patients postoperatively and 4% in sublay technique. Surgical site infection (SSIN) was noticed in 8% of sublay technique whereas 12% in onlay technique. There is no recurrence in sublay group whereas onlay had 12% recurrence.Conclusions: Sublay technique is superior to onlay concerning the hospital stay, complications and recurrence.

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A prospective study on incisional hernia, its incidence, etiology and management in a tertiary care hospital of Odisha

International Surgery Journal ◽

10.18203/2349-2902.isj20191263 ◽

2019 ◽

Vol 6 (4) ◽

pp. 1280

Author(s):

S. K. Pattanaik ◽

Afroza Firodous ◽

Ajax John ◽

Harsha Pattnaik ◽

Biplab Mishra ◽

...

Keyword(s):

Incisional Hernia ◽

Mesh Repair ◽

Tertiary Care ◽

Operating Time ◽

Surgical Techniques ◽

Wound Management ◽

Anatomical Reconstruction ◽

Suture Repair ◽

Care Hospital ◽

Open Mesh Repair

Background: Incisional hernia (IH) is defined as the hernia protruding through incompletely healed abdominal surgical wound. Management of IH can be preventive (avoidance of infection and suture line tension, proper abdominal wound closure) or operative (anatomical reconstruction or repair with synthetic non-absorbable mesh either by open or laparoscopy method).Methods: A descriptive prospective observational study on 51 patients with age >15 yrs was conducted in the Department of General Surgery, SCB Medical College and Hospital, Cuttack from August 2015 to August 2017. Diagnosis was made with clinical history, physical examination, X-ray abdomen and USG abdomen. The patients underwent different surgical procedures depending on size of defect, patient’s consent and expertise available. Post-operative complications were noted and patients were followed up to 1 year for any recurrence.Results: 28 males and 23 females were included. The mean age was 42.3 years. Most common cause of IH was post-operative wound infection (47.1%). Maximum cases were following emergency surgery (88.2%). Midline incision contributes maximum number (52.9%) followed by Pfannenstiel incision (25.4%). Open hernioplasty was the most common procedure (58.8%) followed by anatomical repair (19.6%) and laparoscopic hernioplasty (15.6%). Recurrence with suture repair was 10%, open mesh repair 3.3% and no recurrence was observed following laparoscopic repair.Conclusions: Prevention of IH is to be taken care of, by avoiding infection during index operation with thorough peritoneal toileting, proper surgical techniques and appropriate antibiotics. Although laparoscopic mesh repair needs more operating time and skill, it has lesser blood loss, hospital stay and recurrence rate when compared to other procedures.

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Long-term results of incisional hernia treatment

Medicina ◽

10.3390/medicina43110110 ◽

2007 ◽

Vol 43 (11) ◽

pp. 855 ◽

Cited By ~ 10

Author(s):

Linas Venclauskas ◽

Jolita Šilanskaitė ◽

Jurga Kanišauskaitė ◽

Mindaugas Kiudelis

Keyword(s):

Physical Activity ◽

Incisional Hernia ◽

Mesh Repair ◽

Study Groups ◽

Hernia Recurrence ◽

Suture Repair ◽

Open Mesh Repair ◽

Onlay Technique ◽

Open Mesh

Ventral hernia is a common problem in general surgery practice. Incisional hernia can develop in 15–25% of patients after abdominal surgery. The aim of this study was to compare two different methods of incisional hernia surgery. Materials and methods. A retrospective analysis of database of surgery department from 1997 to 2000 was performed. All patients were divided into two groups. The first group patients were operated using open suture repair (keel technique); the second group patients – using open mesh repair (onlay technique). Long-term follow-up was done by a mail questionnaire. A special questionnaire was sent to all patients. Postoperative evaluation included pain and discomfort in the abdomen, physical activity, and recurrence rate after operation. Statistical evaluation was conduced using descriptive analysis: the unpaired Student t test to compare parametric criterions between two study groups, Mann-Whitney U test to compare the unpaired nonparametric criterions between two study groups, and X2 test to investigate nonparametric criterions between these groups. Results. A total of 202 patients (51 males, 151 females) with incisional hernia were operated during 1997–2000. One hundred seventy-one patients were in the keel technique group, and 31 patients in the onlay technique group. There were no significantly differences in age and sex between these groups. The hospitalization time was significantly longer in the open mesh repair group. The postoperative complication (wound seroma and suppuration) rate was significantly higher in the onlay technique group. One hundred sixty-one patients (79.7%) answered the questionnaire (133 in the keel technique group, 28 the in onlay technique group). The patients’ return to physical activity after surgery was significantly longer in the keel technique group. Forty-one patients (31%) had hernia recurrence in the keel technique group and 3 patients (11%) in the onlay technique group (P<0.05). There were no postoperative deaths in both groups. Conclusions. The rates of postoperative therapeutic complications and hernia recurrence are significantly lower after open mesh repair surgery. Return to normal physical activity after surgery is significantly longer after open suture repair surgery.

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Open Mesh Repair of Incisional Hernia Using a Sublay Technique: Long-Term Follow-up

World Journal of Surgery ◽

10.1007/s00268-007-9118-z ◽

2007 ◽

Vol 32 (1) ◽

pp. 31-36 ◽

Cited By ~ 31

Author(s):

Martin Kurzer ◽

Allan Kark ◽

Simon Selouk ◽

Philip Belsham

Keyword(s):

Incisional Hernia ◽

Mesh Repair ◽

Open Mesh Repair ◽

Sublay Technique ◽

Long Term Follow Up ◽

Open Mesh

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HERNIOPLASTY

The Professional Medical Journal ◽

10.29309/tpmj/2009.16.02.2907 ◽

2009 ◽

Vol 16 (02) ◽

pp. 224-227

Author(s):

MUHAMMAD FAISAL BILALL ◽

MUHAMMAD AKRAM ◽

SUMERA KANWAL ◽

Jawaid Iqbal

Keyword(s):

Incisional Hernia ◽

Wound Infection ◽

Mesh Repair ◽

Enterocutaneous Fistula ◽

Tertiary Care ◽

Rectus Sheath ◽

Fistula Formation ◽

Open Mesh Repair ◽

Sublay Technique ◽

Open Mesh

Incisional hernia is a common complication of abdominal surgery and an important source of morbidity. It may be repairedusing open suture, open mesh or laparoscopic mesh techniques. O b j e c t i v e s : To examine the results of open mesh repair using "sublaytechnique" of hernioplasty. Setting: Surgical Unit-I, Department of Surgery at Allied Hospital, a tertiary care teaching hospital affiliated withPunjab Medical College, Faisalabad. Patient & M e t h o d s : Sixty patients (male:16, female:44) were operated for incisional hernia. Openmesh repair was done. Polypropylene mesh was placed over closed posterior rectus sheath layer and over the rectus abdominis, wereavailable. Anterior rectus sheath was closed in front of the implanted mesh. All the patients received injectable third generation cephalosporinfor 48hrs postoperatively. Postoperative recovery in terms of seroma formation, wound infection, intraabdominal adhesions leading tointestinal obstruction, enterocutaneous fistula formation and recurrence were the main factors noted and analyzed statistically. Results:Mean postoperative hospital stay was 03 days. Only one patient developed wound infection. None of the patients developed seromaformation, intestinal obstruction or enterocutaneous fistula. Maximum follow up till this study is 14 months. No recurrence has been reportedso far. C o n c l u s i o n s : Open mesh repair using "sublay technique" does not carry risk of enterocutaneous fistula, carries low risk of seromaformation and wound infection. Proper technique is not associated with recurrence.

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Comparison of Post-Operative Complications Between Sublay and Onlay Mesh Repair in Incisional Hernia

10.53350/pjmhs2115123384 ◽

2021 ◽

Vol 15 (12) ◽

pp. 3384-3386

Author(s):

Azizullah Khan Sherani ◽

Saleem Javed ◽

Muhammad Idrees Achackzai

Keyword(s):

Incisional Hernia ◽

Wound Infection ◽

Mesh Repair ◽

Seroma Formation ◽

Onlay Technique ◽

Sublay Technique ◽

Operative Complications ◽

Group A ◽

Group B ◽

Post Operative Complications

Objective: To compare the post-operative complications between sublay and onlay mesh repair in incisional hernia. Materials & Methods: This randomized controlled trial was conducted at Department of Surgery, Sandeman Provincial Hospital Quetta from May 2019 to November 2019. Total 250 patients with incisional hernias for more than 3 months, having age 20-40 years either male or female were selected. Then selected patients were placed randomly into two groups i.e. Group A (Sublay group) & Group B (Onlay group), by using lottery method. Patients were called for follow up 15th day for post-operative complications in term of wound infection and seroma formation. Results: The mean age of patients in group A was 34.73 ± 4.32 years and in group B was 34.51 ± 4.67 years. Out of these 250 patients, 161 (64.40%) were female and 89 (35.60%) were males with female to male ratio of 1.8:1. Wound infection was seen in 07 (5.60%) patients in group A (Sublay technique) and 17 (13.60%) patients in group B (Onlay technique) with p-value of 0.033. Seroma formation was seen in 09 (7.20%) patients in group A (Sublay technique) and 26 (20.80%) patients in group B (Onlay technique) with p-value of 0.002. Conclusion: This study concluded that rate of wound infection and seroma formation is less after sublay mesh repair for incisional hernia as compared to onlay repair. Keywords: Hernia, incisional, onlay, sublay, seroma.

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Open Mesh Repair of Incisional Hernia Using a Sublay Technique: Long-term Follow-up

World Journal of Surgery ◽

10.1007/s00268-007-9195-z ◽

2007 ◽

Vol 32 (1) ◽

pp. 37-37

Author(s):

Leif Israelsson

Keyword(s):

Incisional Hernia ◽

Mesh Repair ◽

Open Mesh Repair ◽

Sublay Technique ◽

Long Term Follow Up ◽

Open Mesh

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Role of laparoscopy in incisional hernia and relative benefit of the laparoscopic incisional hernia repair to the open incisional hernia repair

International Surgery Journal ◽

10.18203/2349-2902.isj20202814 ◽

2020 ◽

Vol 7 (7) ◽

pp. 2165

Author(s):

Sudhir Singh Pal ◽

Azad Kumar Mourya

Keyword(s):

Incisional Hernia ◽

Hernia Repair ◽

Hospital Stay ◽

Mesh Repair ◽

Laparoscopic Group ◽

Incisional Hernia Repair ◽

Visual Analogue Score ◽

Laparoscopic Incisional Hernia Repair ◽

Post Operative Pain ◽

Open Mesh Repair

Background: Incisional hernia is a common complication of abdominal surgery. Historically the open repair with or without mesh was the mainstay of treatment. However, many recently published laparoscopic repair studies have challenged surgeons to re-evaluate which technique provides the best short and long term outcomes.Methods: The study was conducted on 50 patients admitted at GMC Bhopal with approval from college ethical committee.Results: In 50 cases 21 were male and 29 were female. 7 male (14%) and 15 female (30%) patients had undergone laproscopic mesh repair (LMR) and 14 male (28%) and 14 female (28%) patients had undergone open mesh repair (OMR). Total complication in OMR group is 10 (35%) and in LMR group is 2 (9.09%). Mean duration of hospital stay in LMR group was 6.6 days and in OMR group was 15.57 days. Post-operative patients of LMR group returned back to the work early (mean 12 days) compared to OMR group (mean 20.7 days). Mean post-operative day of movement in LMR group was 1 day and in OMR group was 2.03 days. Pain measured using visual analogue score on 3rd post-operative day showed decreased pain score in laparoscopic group (mean 2) compared to open group (mean 5.35).Conclusions: Laparoscopic incisional hernia repair provides lesser post-operative pain, lesser complications, shorter hospital stay and lesser economic impact as they returned to work early. Thus patients have less morbidity and improved quality of life.

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Association of The Size of Hernial Defect Over Post- Operative Outcomes Following Mesh Repair of Incisional Hernia

KYAMC Journal ◽

10.3329/kyamcj.v10i1.41474 ◽

2019 ◽

Vol 10 (1) ◽

pp. 2-6

Author(s):

Md Shahajahan Ali ◽

Sayeed Bin Sharif ◽

Kazi Shah Md Abdullah

Keyword(s):

Incisional Hernia ◽

Mesh Repair ◽

Defect Size ◽

Prolene Mesh ◽

Hernia Defect ◽

Respiratory Problems ◽

Operative Outcomes ◽

Onlay Technique ◽

Group 5 ◽

Medium Group

Background: Incisional hernia is a common complication of abdominal surgery. The success and postoperative outcomes of hernia repair depends upon many factors and out of these, the size of the hernial defect plays an important role. Objectives: To determine whether the size of the hernia defect had any impact over post-operative outcomes following prolene mesh repair of incisional hernia. Materials and Methods: Total 52 patients of incisional hernia who underwent prolene mesh repair by onlay technique were selected in this study. Patients were divided into three groups according to the size of hernial defect, as <5cm (small group), 5-10 cm (medium group) and >10cm (large group). Result: Respiratory problems were observed in 3 (42.9%) out of 7 subjects of hernial defect size >10 cm and 2 (6.2%) Out of 32 subjects of hernial defect size 5-10 cm. No subject of hernial defect size <5cm had respiratory problem. Wound infection was observed in 2 (15.4%) out of 13 subjects of hernial defect size <5 cm, 3(9.4%) Out of 32 subjects of hernial defect size 5-10 cm and 4(57.1%) out of 7 subjects of hernial defect size >10 cm. Pain was persistent in 3(5.8%) out of 52(100%) subjects more than 6 months after hernioplasty where 2 (28.6%) out of 7 subjects of hernial defect size >10 cm and 1(3.1%) out of 32 subjects of hernia defect size 5-10 cm. So, larger hernial defect was significantly associated with more pain persistence (p= 0.019). Conclusion: Larger hernial defect is associated with more post-operative complications and increase morbidity. KYAMC Journal Vol. 10, No.-1, April 2019, Page 2-6

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