Evaluation of Preperitoneal Mesh Repair vs Onlay Mesh Repair for Hernia Surgery

Abstract

Background: A ventral hernia in the anterior abdominal wall includes both spontaneous and incisional hernias after an abdominal operation. Mesh repair can be onlay or pre-peritoneal. Controversy exists regarding the use of the type of either meshplasty, due to differences in ease in performing the surgery, time of surgery, complications occurring in the post-operative period and the recurrence. Aims: To study the anatomical, etiological and clinico-pathological factors leading to ventral hernias. And To study the different techniques of repair of ventral hernia with emphasis on pre-peritoneal and onlay mesh repair and their outcomes. Materials and Methods: 60 patients presenting with the ventral hernias were preoperatively assessed clinically and by ultrasonography to confirm the diagnosis. 30 patients each underwent pre-peritoneal and onlay mesh repair after obtaining consent and satisfying the inclusion and exclusion criteria. Results: Seroma formation, infection, and chronic pain were seen in 20%, 13.33%, 20% patients, respectively, in onlay mesh repair group and in 10%, 6.66%, and 3.33% patients, respectively, in pre-peritoneal mesh repair group. Recurrence was seen in 10% patients in onlay group. No recurrence was seen in the pre-peritoneal mesh repair group. Associated factors’ morbidity was also found to be higher in onlay group. Conclusion: Seroma formation, infection, and the chronic pain were commonly associated with onlay mesh repair compared to pre-peritoneal mesh repair. Recurrence is higher in cases of ventral hernias operated by onlay mesh repair especially in cases with co-morbidities such as obesity, diabetes, and multiparity. Considering all these observations, we concluded that pre-peritoneal mesh repair is superior to onlay mesh repair.