INCISIONAL HERNIA-ONLAY VS SUBLAY MESH HERNIOPLASTY

NAME ADDRESS EMAIL ID OF THE CORRESPONDING AUTHOR:
Dr. A. Ravi Kamal Kumar,
Flat No. 10, Garudadri Towers,
Maruthi Nagar,
Guntur-522006.
E-mail: ravikka@rediffmail.com

ABSTRACT: BACKGROUND: Incisional hernia is a common surgical problem. Anatomical repair of hernia is now out of vogue. Polypropylene mesh repair has now become accepted. In open mesh repair of incisional hernia cases the site of placement of mesh is still debated. Some surgeons favour the onlay repair and others use sublay or retro-rectus plane for deployment of the mesh. AIM: The aim of the study is to examine the pros and cons of both the techniques and find the better one. METHODS: A prospective study was conducted of 37 cases of incisional hernia admitted in Govt. General Hospital Guntur from Jan 2012 to Dec 2013. 20 of the cases underwent open mesh repair by onlay method whereas 17 cases underwent open mesh repair by the sublay i.e. retrorectus placement of the mesh. Observations were made regarding time taken for both types of repairs, post-operative complications like flap necrosis, wound seroma, wound infecton, postoperative ileus etc., after discharge from the hospital the cases were followed up in the OPD upto Dec. 2014 and any complications and recurrences were noted. OBSERVATIONS AND RESULTS: Most of the cases (75%) were female and the incisional hernias were in the lower abdomen. The time taken for the surgery is more in the sublay group and the postoperative pain score is also more in the sublay group. But the wound complications like wound infection and flap necrosis were more (25-30%) in the onlay group. Also one case (5%) developed recurrence. Though the time taken for the surgery and the skill needed is more for the sublay group the wound complications are acceptable in the sublay group. Also there are no recurrences observed in the sublay group. But no statistically significant difference (p<0.7) is detected when all the post-operative complications are taken together between the sublay and onlay repair techniques. CONCLUSIONS: Although it can be argued, theoretically and by the wound complication rate, in favour of sublay placement of the mesh, still the quest continues for the ideal technique of hernia repair in the Indian scenario. A well-constructed randomised clinical trial is needed to find the best method of incisional hernia repair.

KEYWORDS: Incisional hernia, onlay mesh repair, sublay mesh repair.