A Comparative Study of Retro Rectus and Onlay Mesh Repair by Open Surgical Technique in Ventral Hernias

Background: Ventral hernia repair is a commonly performed surgical procedure with over a million cases annually in India. Traditional suture repair methods have high recurrence rates, especially in larger hernias. The advent of synthetic mesh has revolutionized hernia repair, significantly reducing recurrence. However, the optimal placement of the mesh—whether onlay or retrorectus (sublay)—remains debated. This study aims to compare the outcomes of onlay and retrorectus mesh repair in patients undergoing ventral hernia repair by open surgical technique. Materials and Methods: A prospective comparative study was conducted from May 2023 to May 2024 at Dr. Bhim Rao Ambedkar Memorial Hospital and District Hospital in Raipur, enrolling 60 patients diagnosed with ventral hernias. Patients were divided into two groups: Group A (onlay mesh repair) and Group B (retrorectus mesh repair), with 30 patients each. Intraoperative and postoperative variables, including surgical duration, complications (seroma, surgical site infections), and hospital stay, were recorded. Data were analyzed using SPSS version 20.0, applying unpaired t-tests, Chi-square, and Fisher’s exact tests as appropriate. Results: The mean age of participants was 45.87 years. Group A (onlay) had a significantly higher rate of seroma formation (20% vs. 4% in Group B, p<0.05) and surgical site infections (16% vs. 4% in Group B, p<0.05). The mean hospital stay was longer for the onlay group at 5 days compared to 4 days for the retrorectus group (p<0.0002). Additionally, drain duration was prolonged in the onlay group due to increased seroma formation, suggesting greater postoperative morbidity associated with this technique. Conclusion: Retrorectus mesh repair offers advantages over the onlay approach, showing lower rates of complications, shorter hospital stays, and reduced drain duration. These findings support the retrorectus technique as a preferred method for ventral hernia repair, providing better outcomes with lower morbidity.