Balakrishnan Subramani1, Durairaj Muniyaswamy2, Swathi Prakash Jayaprakash3, Rasu Kuruji4
BACKGROUND
Ventral hernia in the anterior abdominal wall includes both spontaneous and most commonly incisional hernias after an abdominal operation. Mesh repair can be preperitoneal or onlay. Hernia recurrence is distressing to patient and embarrassing to surgeons. Controversy exists among the surgeons regarding the use of type of either mesh repair due to differences in ease in performing the surgery, time of surgery, complications occurring in the postoperative period and the recurrence. The study aimed to study the different techniques of repair of ventral hernia with special emphasis on preperitoneal mesh repair and onlay mesh repair and their outcome.
MATERIALS AND METHODS
In our study, 50 patients with ventral hernia attending and admitted to Royapettah Hospital and Kilpauk Medical College Hospital from November 2014 to April 2015 treated with preperitoneal and onlay mesh repair were analysed. 50 patients presenting with ventral hernia admitted were preoperatively assessed clinically and by ultrasonography to confirm the diagnosis. 30 patients each underwent preperitoneal and onlay mesh repair after obtaining consent and satisfying the inclusion criteria.
RESULTS
Results were analysed based upon the factors like ease of operation, time taken for the surgery, associated factors, complications and recurrence. We observed seroma formation, wound infection and flap necrosis in 36%, 32%, 16% patients respectively in onlay mesh repair group and in 12%, 8%, 0% patients respectively in preperitoneal mesh repair group. Recurrence was seen in 16% patients in onlay group. No recurrence was encountered in the preperitoneal mesh repair group. Associated factor morbidity was also found to be higher in onlay group.
CONCLUSION
Considering the burden of surgeries especially in third world countries with limited number of surgeons, it could provide valuable alternative over preperitoneal repair. Ease of the procedure in performing onlay mesh repair over preperitoneal repair gives it the points over preperitoneal, but associated complications limits its use. Based upon the above results, we observed preperitoneal mesh repair is superior than onlay mesh repair in ventral hernia.
