Small and Laterally Placed Incisional Hernias Can be Safely Managed with an Onlay Repair

Area of Science:

• Abdominal Surgery
• Hernia Repair
• Surgical Techniques

Background:

• Systematic reviews favor the sublay technique for incisional hernia repair.
• However, the onlay mesh location has potential utility in specific clinical scenarios.

Purpose of the Study:

• To compare the outcomes of sublay versus onlay mesh techniques for incisional hernia repair.
• To evaluate differences in complications, pain, and recurrence rates between the two techniques.

Main Methods:

• Analysis of data from the Herniamed Registry, comparing 6797 sublay and 1024 onlay operations.
• Propensity score matching was used to create 1016 comparable pairs based on patient and hernia characteristics.

Main Results:

• Unadjusted analysis indicated onlay use for smaller, lateral defects and in women.
• Propensity score-matched analysis revealed no significant differences in intra/postoperative complications, general complications, reoperations, pain levels, or 1-year recurrence rates.

Conclusions:

• In carefully selected patients with small, lateral incisional hernias and a high proportion of women, the onlay and sublay mesh techniques yield comparable outcomes.
• These findings suggest the onlay technique may be a viable option in specific patient populations.