P063 COMPARATIVE ANALYSIS OF INCISIONAL HERNIA REPAIRS WITH MESH IN SUBLAY AND ONLAY POSITION: PROSPECTIVE SERIES

Aim Sublay mesh placement in incisional hernia repair (IH) does not seem to show lower surgical site infection (SSI) or recurrence than onlay placement, according to a recent review. Our aim was to analyze both techniques in an abdominal wall department. Material and Methods Prospective data collection of all IHs for four years. Results were analyzed at one month and during follow-up. The characteristics of IH, operative time, incidence of SSI and recurrence was compared by groups depending on location of the mesh in sublay (SM) or onlay (OM). Results “The surface area of the hernial defect was greater in the SM group (216±338 vs 68±84cm2; P = 0.002), as well as longer surgical time (131±91 vs 70±54 min; P < 0.001). A higher number of hematoma was diagnosed in the SM (OR 1.39; CI95% 1.21-1.60; P = 0.18) in 88 operations. No differences were observed in the incidence of SSI between the groups (27.7 vs 21.7%; P = 0.78). 74 patients completed a mean follow-up of 11.4 months, any difference in IH recurrence appeared (5.8 vs 9.1%; P = 0.63) in SM group vs OM group, respectively. Conclusions A SM repair is performed in IHs with large defects, which entails a longer surgical time and the appearance of hematoma, although no statistically significant differences in the rate of SSI or IH recurrence was observed between SM and OM repair.

Onlay and sublay mesh repair in incisional hernias: our experience from GSL medical college and hospital, Rajahmundry

Background: The incidence of post-operative wound infection and wound-related complications due to mesh repair aimed at continuing research into the optimal method of treatment of these hernias. 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. Objectives were to compare the morbidity and complications associated with onlay and sublay mesh repair in the management of incisional hernias.Methods: The present descriptive observational study was carried out in patients admitted in surgical wards at GSL medical college and hospital, Rajahmundry who are clinically diagnosed to have incisional hernia. The study was carried out from January to November 2019. Data was analysed with SPSS 23.0.Results: Seroma was seen in 12% and 8% respectively from onlay and sublay group and this proportion of seroma was more in onlay group as compared to sublay group (<0.05). Postoperative recurrence of hernia was seen in both groups equally. Number of days of hospitalization in sublay group was less as compared to onlay group. Deep surgical site infection (SSI) was seen in 8% and 4% respectively from onlay and sublay group.Conclusions: Sublay mesh repair has a lower rate of post-operative complications than onlay mesh repair, deep SSI leading to infection of mesh is higher in on‑lay mesh repair. Number of days of hospitalization in sublay group was less as compared to onlay group.

Comparison of Onlay versus Sublay Mesh Repair in Ventral Hernia : Our Experience in a Peripheral Hospital

Background: Mesh repair is the standard procedure of choice for the ventral hernia repair. The common techniques for this surgery are onlay and sublay repair. But the superior technique between the two is yet to be established objectives. Objectives: We conducted this study to compare the results of Onlay with Sublay mesh repair for the treatment of ventral hernia. Methods: This comparative study was conducted at the department of Surgery, Shaheed Tajuddin Ahmad Medical College Hospital, Gazipur from April 2018 to April 2019. 20 patients withclinically diagnosed ventral hernia were randomized into two groups. The patients in group A had onlay mesh repair while those of group B hadsublay mesh repair. Comparison between the two methods were made in terms of operative time, technical ease, early post operative events specially drain & complication, hospital stay, recurrence. Result: Twenty patients between 20 to 70 years of age among whom 6 are male and 14 are female with different types of ventral hernia including paraumbilical, umbilical, epigastric and incisional, except with defect more than 15 cm were studied. The sublay repair took significantly longer operative time (p = .023). Onlay repair group had more seroma formation, wound infection and recurrence, though not statistically significant. Patients who underwent sublay repair had early removal of drains (3.7 ± .823 days vs 6 ± .738 days) which was significant (p= .000). At the same time sublay repair group had significantly shorter hospital stay than the onlay group (4.5 ± 1.900 days vs 6 ± 1.354 days, p= .023). Conclusion: Sublay repair seems to be a better alternative than onlay repair of Ventral hernia. Randomised controlled trial with larger case numbers is needed to validate the result. Journal of Surgical Sciences (2020) Vol. 24 (2) : 61-65

Hybrid laparoscopic and open repair of post-nephrectomy flank hernia

Surgical repair of flank hernia is not routinely performed, due to perceived technical difficulties with the surgery and risk of recurrence, or the misconception that flank hernia is solely due to a denervation injury. Due to the rareness of flank hernia in the literature, there is no general consensus on the best method of surgical repair. We present the case of a patient with a symptomatic large flank hernia following open nephrectomy, in which a hybrid technique of open and laparoscopic flank hernia repair with sublay mesh and bone anchor fixation was successfully performed with good outcome. This case highlights the benefits of the hybrid approach, which allowed a laparoscopic assessment of the defect and adhesiolysis, followed by the open repair which enabled adequate mesh overlap, fixation to surrounding tissues and bone anchor fixation.