Comparison of Operative and Postoperative Outcomes of Onlay, Sublay, and Laparoscopic Mesh Repair for Paraumbilical Hernia

Background: Paraumbilical hernias are common ventral wall defects in adults, with surgical repair required to prevent complications. Mesh repair techniques—including onlay, sublay, and laparoscopic approaches—differ in operative complexity and postoperative outcomes. Aim: To compare operative and early postoperative outcomes of onlay, sublay, and laparoscopic mesh repair techniques for paraumbilical hernia. Methods: A retrospective observational study was conducted on 75 adult patients who underwent elective paraumbilical hernia repair at Safeer Al-Imam Al-Hussain Surgical Hospital, Iraq, between May 2022 and February 2025. Patients were categorized into sublay (n=28), onlay (n=22), laparoscopic (n=20), and primary suture repair (n=5) groups. Demographic, clinical, operative, and early postoperative data, including seroma, infection, and drain duration, were collected. Results: The mean age was 45.8 ± 14.5 years, with 82.7% female. Obesity (BMI ≥30) was present in 25.3%. Sublay repair required the largest mesh (105.3 ± 15.6 cm²) and longest operative time (55.9 ± 12.3 min), while laparoscopic repair had the shortest operative time (35.4 ± 9.1 min) and smallest mesh (74.9 ± 10.6 cm²). Seroma occurred in 17.9% of sublay, 18.2% of onlay, and 5% of laparoscopic repairs (p=0.164). Infection rates were 10.7%, 9.1%, and 5%, respectively (p=0.284). Drain removal was significantly shorter in laparoscopic (3.2 ± 0.9 days) and suture repair (2.8 ± 0.7 days) compared with open repairs (p<0.037). Seroma was significantly associated with BMI ≥30 (p=0.041), defect size ≥5 cm (p=0.029), and operative time ≥90 min (p=0.023). Infection was associated with BMI ≥30 (p=0.011) and operative time ≥90 min (p=0.014). Conclusion: Laparoscopic repair offers shorter operative time, smaller mesh requirements, and lower seroma rates, making it favorable in selected patients. Sublay repair, while technically more demanding, is suitable for larger defects. Obesity and prolonged operative time are key risk factors for postoperative complications, and careful surgical planning is recommended to optimize outcomes.