COMPARATIVE STUDY OF ONLAY VERSUS SUBLAY MESH REPAIR IN VENTRAL HERNIA: A RANDOMIZED CONTROLLED TRIAL.

Background: Ventral hernia repair is one of the most frequently performed procedures in general surgery. While mesh reinforcement has reduced recurrence, the optimal plane of mesh placement is still debated. Onlay mesh repair is technically easier but carries higher risk of wound complications. Sublay repair, though technically demanding, is thought to reduce complications. Objective: To compare clinical outcomes between onlay and sublay mesh repair in patients undergoing ventral hernia surgery. Methods: In this randomized controlled trial, 60 patients with primary or incisional ventral hernia were randomized to undergo onlay (n=30) or sublay (n=30) mesh repair. Data collected included operative time, surgical site infection (SSI), seroma formation, drain duration, length of hospital stay, and recurrence. Statistical analysis was performed using SPSS v20. Results: Sublay repair was associated with significantly fewer SSIs (10% vs 30%, p=0.04) and seromas (6.6% vs 26.6%, p=0.03). The mean hospital stay was significantly shorter in the sublay group (6.2 ± 1.1 vs 8.1 ± 1.3 days, p=0.001). Operative time was longer in sublay repair (92.3 ± 15.5 vs 86.7 ± 12.9 minutes, p=0.08), but the difference was not statistically significant. At 12-month follow-up, recurrence was comparable in both groups (one case each). Conclusion: Sublay mesh repair results in fewer complications and shorter hospitalization compared to onlay repair, despite requiring slightly longer operative time. Sublay should be considered the preferred method in elective ventral hernia surgery.