Retromuscular prefascial mesh placement versus onlay mesh placement in the repair of incisional hernias: a prospective study

Authors

  • Ranganath M. Venkatarangaiah Consultant Surgeon, General Hospital, Sira, Tumkur, Karnataka, India
  • Darshan A. Manjunath Department of General Surgery, McGann Hospital, Shivamogga Institute of Medical Sciences, Shivamogga, Karnataka, India
  • Amarnath V. Mudda Department of Surgery, Basaveshwar Hospital, Gulbarga, Karnataka, India
  • Veerabhadra Radhakrishna Department of Pediatric Surgery, Manipal Hospital, Kodihalli, Bengaluru, Karnataka, India http://orcid.org/0000-0002-8733-4892

DOI:

https://doi.org/10.18203/2349-2902.isj20175552

Keywords:

Incisional hernia, Onlay mesh repair, Retromuscular prefascial mesh repair

Abstract

Background: An incisional hernia is a common complication of abdominal surgery with an incidence rate of two to 11%. Although there are various techniques described, the mesh repair has been the gold standard in the elective management of incisional hernias. But the best method of mesh placement is still debatable. Hence a study was conducted to compare the Retromuscular prefascial mesh placement with Onlay mesh placement in the treatment of incisional hernias.

Methods: A prospective study was conducted in the Department of General Surgery in a tertiary center from November 2010 to May 2012. All patients with an incisional hernia underwent either Retromuscular prefascial mesh repair or onlay mesh repair. The nature of the previous surgery, size of the defect, operative, and postoperative complications were recorded. Mann Whitney test and Fisher’s exact test was used to evaluate the significance of the difference. A ‘p’ value <0.05 was considered significant.

Results: A total of 60 patients were studied with 30 patients each in the Retromuscular prefascial group and the onlay group. Forty (67%) cases of incisional hernia were secondary to lower midline incision and hysterectomy was the most common surgery [30 patients (50%)]. The Retromuscular prefascial mesh group had significantly lesser postoperative complications (2/30 vs. 12/30; p=0.002; Fischer’s exact test) and seroma formation (1/30 vs. 8/30; p=0.02; Fischer’s exact test) compared to the onlay mesh group.

Conclusions: Retromuscular prefascial mesh repair was equally effective but associated with fewer complications compared to onlay mesh repair.

References

Parekh JN, Shah DB, Thakore AB. Incisional Hernias. Ind J Surg. 1980;50:49.

Abrahamson J. Hernias. In: Zinner MJ, Schwartz SI, Ellis H, eds. Maingot’s Abdominal Operations. 10th Ed. Prentice Hall International; 1997:548-580.

Kingsnorth AB, Giorgobiani G, Bennett DH. Hernias: umbilical and abdominal wall. In: Williams NS, Bulstrode CJK, O'Connell PR, eds. Bailey and Love's Short practice of surgery. 25th Ed. London: Arnold; 2008:987-989.

Malangoni MA, Rosen MJ. Hernias. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th Ed. Philadelphia, Pa: Saunders Elsevier; 2008:1173.

Seymour NE, Bell RL. Abdominal Wall, Omentum, Mesentery, and Retroperitoneum. In: Brunicardi F, Andersen D, Billiar T, Dunn D, Hunter J, Matthews J, et al, eds. Schwartz's Principles of Surgery. 9th Ed. New York: McGraw Hill; 2009:1267-74.

Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR, Committee THICPA. Guideline for Prevention of Surgical Site Infection, 1999. Infect Control Amp Hosp Epidemiol. 1999;20(4):247-80.

Trupka AW, Hallfeldt KK, Schmidbauer S, Schweiberer L. Management of complicated incisional hernias with underlay-technique implanted polypropylene mesh. An effective technique in French hernia surgery. Chirurg. 1998;69:766-72.

Bucek J, Jerabek J, Piskac P, Novotny T. Retromuscular mesh repair of a hernia in a scar according to Rives - our first experience. Rozhl Chir 2005;84(11):543-6.

Langer S, Christiansen J. Long-term results after incisional hernia repair. Acta Chir Scand. 1985;151:217-9.

Bhutia WT, Chandra SS, Srinivasan K. Factors predisposing to incisional hernia after laparotomy and influencing recurrence rates after different methods of repair - a prospective study of 220 patients. Ind J Surg. 1993;55:535-43.

Ponka JL. The hernia problem in the female. In: Ponka JL. Hernias of the abdominal wall. Philadelphia: W B Saunders;1980:2-90.

Bucknall TE, Cox PJ, Ellis H. Burst abdomen and incisional hernia: a prospective study of 1129 major laparotomies. Br Med J. 1982;284:931-3.

Luijendijk RW, Lemmen MH, Hop WC, Wereldsma JC. Incisional hernia recurrence following “vest-over-pants” or ventral mayo repair of primary hernias of the midline. World J Surg. 1997;21:62-5.

deVries Reilingh TS, Van Geldere D, Langenhurst B, Dejong D, van der wilt GJ, van GH. Repair of large midline incisional hernias with polypropylene mesh: Comparison of three operative techniques. Hernia 2004;8(1):56-9.

Machairas A, Misiakos EP, Liakakos T, Karatzas G. Incisional hernioplasty with extraperitoneal Onlay polyester mesh. Am Surg. 2004;70:726-9.

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Published

2017-12-26

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Original Research Articles