Sublay mesh versus Onlay mesh: a randomized comparative study

Introduction. Ventral hernias are the second most common hernia; Onlay and Sublay operating techniques are procedures commonly performed in such cases. There is no consensus on the superiority of these procedures. The aim of this study was to compare the results of both procedures in order to identify the recommended technique between the two options. Materials and Methods. A total of 106 patients with epigastric, umbilical, paraumbilical, incisional hernias were studied. These patients were grouped into group A (onlay) and Group B (sublay). The outcomes of the two techniques were compared with respect to operative time, pain, hospital stay, seroma, infection, recurrence and patient satisfaction. Results. The mean operative time was 81.30 minutes in group A, and 85.85minutes in group B. Twenty-two (42.5%) patients in group A and seven (12.96%) patients in group B developed seroma. Nine (17.3%) patients in group A, 3 (5.55%) patients in group B developed post-operative infection. 30 (57.69%) patients in group A and 47(87.3%) patients in group B reported moderate pain, whereas three (5.76 %) and seven (12.96%) patients in group A and group B were reported severe pain in immediate post-operative period. At 48 hours, 20 (38.46%) and 24 (44.44%) of patients in group A and B were reported moderate pain, whereas 32 (61.53%) and 30 (55.55%) patients in group A and B reported mild pain. The mean hospital stay was 10.11 days in group A and 6.22 in group B. Three (5.76 %) patients of group A has recurrence, none of the patients in sublay group has developed recurrence. Thirty-nine (72.22%) patients of sublay group expressed their satisfaction but only 20 (38.46%) patients in onlay group expressed their satisfaction. Conclusion. With reference to all the study parameters except one, the sub lay technique of mesh placement appears to be better. The exception is pain in the immediate postoperative period.