A Prospective Comparative Study of Preperitoneal vs. Retro-Rectus Mesh Placement in Ventral Hernia Repair at a Tertiary Care Hospital

Background Ventral hernia repair commonly requires mesh reinforcement. Among various open approaches, preperitoneal and retro-rectus mesh placements are frequently practiced, but their comparative outcomes remain debated. Aim The aim of the study is to compare postoperative outcomes of preperitoneal versus retro-rectus mesh placement in open ventral hernia repair in a tertiary care hospital. Methods A prospective, randomized comparative study was conducted on 28 patients undergoing open ventral hernia repair. Patients were randomized using block randomization into two groups: Group A (preperitoneal mesh, n = 14) and Group B (retro-rectus mesh, n = 14). Postoperative complications, duration of hospital stay, pain (Visual Analog Scale (VAS) score), and post-surgical occupational downtime were assessed. All patients were followed up for one month postoperatively. Statistical analysis was performed using the chi-square test for categorical variables and the independent t-test for continuous variables, with p < 0.05 considered statistically significant. Results The retro-rectus mesh repair group demonstrated lower rates of seroma formation (one patient out of 14 patients vs. three patients out of 14 patients (7.14% vs. 21.4%, p = 0.042)) and surgical site infection (SSI; one patient out of 14 patients vs. two patients out of 14 patients (7.14% vs. 14.3%, p = 0.037)) compared to the preperitoneal group. The mean hospital stay was significantly shorter in the retro-rectus group (5.3 ± 1.1 days) than in the preperitoneal group (6.8 ± 1.4 days, p = 0.021). Post-surgical occupational downtime was also reduced (8.5 ± 2.1 days vs. 11.3 ± 2.5 days, p = 0.018). Conclusion Retro-rectus mesh repair offers lower postoperative morbidity, shorter hospital stay, and faster recovery compared to preperitoneal repair, with comparable short-term outcomes at one-month follow-up. It may be considered the preferred approach in tertiary care settings.