Comparison of early and late term results of onlay and sublay mesh approaches in open incisional hernia surgery

Aims: Despite the increase in minimally invasive techniques, open techniques continue to be frequently used in incisional hernia repairs. In open incisional hernia surgeries, onlay and sublay techniques are the most frequently preferred depending on the area where the mesh is placed. In this study, we aimed to compare these two techniques by analyzing perioperative findings. Methods: Data from elective open incisional hernia surgeries (onlay and sublay) performed by the same surgical team in the general surgery clinic between 01.01.2023 and 31.12.2023 were retrospectively reviewed. Emergency surgeries, laparoscopic or combined surgeries, patients who did not undergo mesh repair, patients who received preoperative botulinum toxin due to “loss of domain”, patients with missing data, and patients who did not continue their follow-up were excluded from the study. Results: The data of a total of 74 patients who met the inclusion criteria were analyzed in the study. Onlay procedure was performed in 53 (71%) patients and sublay procedure was performed in 21 (19%) patients with a retromuscular approach. No intraoperative complications were detected in any of the patients. There were statistically significant differences between the groups in terms of female gender (p: 0.007), duration of surgery (p<0.001) and duration of hospital stay (p<0.001). There were no statistically significant differences between the groups in terms of complications (p:0.42), unexpected re-admission (p:0.779) and six-month recurrence (p: 0.779). Conclusion: Onlay or sublay techniques can be safely applied in open incisional hernia surgery because they have acceptable complication and recurrence rates. Surgical experience and patient factors are the main determinants of which technique to apply.