A randomized controlled comparison of sublay and onlay mesh techniques in ventral abdominal wall hernia repair

Abstract

Objective: To compare wound infection, seroma formation, and hernia recurrence rates between onlay and sublay mesh repair for ventral abdominal wall hernias.

Methodology: This prospective, randomized controlled trial was conducted at Recep Tayyip Erdogan Hospital, Muzaffargarh, Pakistan, from February 2022 to August 2023. Ninety-six patients aged 18–60 years with ventral hernias (defect size 40–100 mm) were randomly assigned to onlay or sublay mesh repair (48 per group). Outcomes—wound infection, seroma, and recurrence—were evaluated during hospitalization and at two week and six month follow-ups. Data were analyzed using SPSS v26.0; p ≤ 0.05 was considered significant.

Results: The mean age was 43.4 ± 8.8 years in the onlay group and 44.5 ± 11.2 years in the sublay group (p = 0.592). Wound infections occurred in 22.9% of onlay versus 8.3% of sublay patients (p = 0.049). Seroma formation occurred in 8.3% versus 4.2% (p = 0.678), and recurrence in 0% versus 2.1% (p = 0.495), respectively. In defects 5.1–10 cm, infection was significantly higher in onlay repairs (37.5% vs 12%; p = 0.03).

Conclusion: Sublay mesh repair significantly reduced wound infections compared with onlay repair, with comparable seroma and recurrence rates, supporting its preference in resource-limited settings.

Registration No.: ClinicalTrials.gov (NCT07140471).