Sublay (Retro muscular) Mesh Reinforcement Technique for Open Incisional Hernia Repair: A Preferable Method to Onlay Regarding Early Outcome

Abstract

Background: Incisional hernia after laparotomy is a well-known complication and the repair has always been a challenge to the surgeons. Various operative techniques for the repair of incisional hernia are in practice among which the retro muscular mesh placement or the sublay technique popularized by Rives and Stoppa, has been reported to be quite effective, with low recurrence rates (0-23%) and minimal complications. In the study we tried to evaluate and compare the early clinical outcome in terms of patient morbidity and procedure related complication of both sublay and onlay mesh repair technique. Objective: To evaluate and compare the early post-operative outcome of sublay versus onlay mesh repair in the treatment of incisional hernia. Methods: The study was conducted at the Department of Surgery, Sir Salimullah Medical College & Mitford Hospital and Department of Surgery, BIRDEM General Hospital over a period of one year (from December 2019 to November 2020). It was a prospective randomized control trial using 30 cases, Group A sublay (experimental group) and Group B onlay (control group) – 15 patients in each group. The study was approved by the Institutional Ethical Committee. All the patients were followed up postoperatively up to 6 weeks. Data were analysed by SPSS version 23. Results: Regarding post-operative pain, in Group - A patients, pain score was significantly lower than Group - B patients at 24, 48 & 96 hours (p <0.001, <001 and <0.05 respectively). In regards of drain removal, Group A patients were benefited by early drain removal than Group B (p <0.015). Mean hospital stay was lower in Group A which was statistically significant. Regarding early postoperative outcome, none of the patients in both groups have experienced the common postoperative complications (seroma formation, wound dehiscence, wound infection, mesh reaction & paralytic ileus) in treatment of incisional hernia. This is possibly because of the adequate pre-operative preparation of the patients, preparation of the operative site and meticulous postoperative care. The mean operative time taken in this study was 106.00 ± 29.71 in case of group A and 119.67 ± 44.90 in case group B with P value of 0.418, which is statistically insignificant. The mean age, sex, BMI of the sample population, clinical presentations and per operative findings were comparable. Conclusion: In this study sublay mesh repair showed excellent short-term results, with minimal morbidity. So, it is a good alternative to onlay mesh repair that may be applicable to all forms of incisional hernia.

Bangladesh Crit Care J March 2025; 13 (1): 39-45