Sublay versus underlay in open ventral hernia repair.

Area of Science:

• Surgical Innovation
• Hernia Repair Techniques
• Abdominal Wall Reconstruction

Background:

• The optimal mesh placement for open ventral hernia repair (OVHR) is debated.
• Current trends favor underlay or sublay techniques.
• This study investigated the comparative outcomes of sublay versus underlay mesh placement in OVHR.

Purpose of the Study:

• To compare the rates of surgical site infections (SSIs) and hernia recurrence between sublay and underlay mesh placement in OVHR.
• To evaluate the impact of mesh position on patient outcomes.
• To provide evidence for optimizing surgical techniques in hernia repair.

Main Methods:

• A multi-institution database of OVHRs from 2010-2011 was analyzed.
• Patients with sublay or underlay mesh placement and at least one month of follow-up were included.
• Multivariate logistic and Cox regression analyses were performed for SSI and recurrence, respectively.

Main Results:

• Sublay repair was associated with significantly lower hernia recurrence rates (HR 0.4, CI 0.2-0.8).
• No significant difference in overall SSI rates was found between sublay and underlay repair (OR 1.5, CI 0.8-2.8).
• In a subgroup of elective, midline incisional hernias, sublay repair showed higher overall SSIs but no difference in major SSIs, with fewer recurrences.

Conclusions:

• Sublay mesh placement in OVHR is associated with reduced hernia recurrence compared to underlay repair.
• There is no significant difference in surgical site infections between sublay and underlay repair.
• Further randomized controlled trials are recommended to confirm these findings.