A comparative study of on-lay and sub-lay mesh repair of ventral wall hernias in a tertiary health care centre

Dharmendra B. L., Vijaykumar N.


Background: Ventral hernia is a common occurrence in abdominal surgeries and an important source of morbidity. A wide spectrum of surgical techniques have been developed, ranging from suturing techniques to various types of prosthetic mesh repair. Use of mesh repair technique showed a reduced number of postoperative complications and recurrence compared with other techniques. The exact technique of mesh repair is still debated. The purpose of this study was to compare the traditional on‑lay mesh and sublay mesh placement in ventral hernia repairs in terms of time taken for surgery, duration of drainage after surgery, early complication and delayed complications.

Methods: This is a prospective study which was conducted in the surgical department of our hospital. A total of 50 cases were included in this study. Of these cases, 25 cases were operated by the on‑lay mesh method and 25 by sublay mesh placement.

Results: The operative time for sublay mesh placement was significantly higher than that of on‑lay mesh repair, whereas, the duration of post-operative suction drainage was significantly lower in case of the sublay group. Occurrence of complications like superficial surgical site infection and seroma formation were statistically insignificant in both the study groups, although frequency of complications was lesser in the sublay group. The recurrence rate was found to be 12% in on‑lay mesh repair and 8%in sublay(retro‑rectus) mesh repair.

Conclusions: Sublay mesh repair is a better method than onlay repair with respect to the duration of the post-operative suction drainage. A lower rate of complications and a lower rate of recurrence was seen in the sublay mesh repair group.


On lay, Mesh repair, Sub lay

Full Text:



Zinner MJ, Ashley SW. Maingot’s Abdominal Operations 12th Ed. New York, Mcgraw Hill Medical: 2013.

Yeo CJ. Shackelford’s Surgery of the Alimentary Tract. 6th Edn. Philadelphia, Saunders Elsevier; 2002.

Venclauscas L, Maleckas A, Kiudelis M. One-year follow-up after incisional hernia treatment: results of a prospective randomized study. Hernia. 2010;14:575-82.

Demetrashvili Z, Pipia I, Loladze D, Metreveli T, Ekaladze E, Kenchadze G, et al. Open retromuscular mesh repair versus onlay technique of incisional hernia: A randomized controlled trial. Int J Surg. 2017;37:65-70.

Murad QAF, Awan TA, Khan A, Malik ZA. Onlay versus sublay technique of repairing ventral abdominal hernia. JRMC. 2013;17(2):192-4.

Godara R, Garg P, Raj H, Singla SL. Comparative evaluation of sublay versus onlay meshplasty in ventral hernias. Ind J Gastro. 2006;25.

Jat MA, Memon MR, Rind GH, Shah SQA. Comparative evaluation of “Sublay” versus “Inlay” meshplasty in incisional and ventral hernias. Pak J Surg. 2011;27(1):54-8.

Leithy M, Loulah M, Greida HA, Baker FA, Hayes AM. Sublay hernioplasty versus onlay hernioplasty in incisional hernia in diabetic patients. Menoufia Med J. 2014;27:353-8.

Weber G, Baracs J, Horvath OP. Onlay mesh provides significantly better results than Sublay reconstruction. Prospective randomized multicenter study of abdominal wall reconstruction with sutures only, or with surgical mesh- results of five-years follow-up. Magyar Sebeszet. 2010;63:302e311.