QUALITY OF LIFE AND PATIENT-REPORTED OUTCOMES FOLLOWING ONLAY VERSUS SUBLAY MESH REPAIR IN VENTRAL HERNIA: A RANDOMIZED CONTROLLED TRIAL

Background: While surgical outcomes such as recurrence and wound complications remain primary endpoints in hernia repair studies, patient-reported outcomes (PROMs) have emerged as equally important measures of success. These include postoperative pain, physical function, and health-related quality of life (HRQoL).   Objective: To compare PROMs, including pain and HRQoL, in patients undergoing onlay versus sublay mesh repair for ventral hernia.   Methods: A randomized controlled trial was conducted with 60 patients, equally allocated to onlay (n=30) and sublay (n=30) mesh repair groups. Pain was assessed using Visual Analogue Scale (VAS) at 24 hours, 48 hours, 1 week, and 1 month. Quality of life was assessed using the Short Form-36 (SF-36) questionnaire preoperatively and at 3 months post-surgery. Statistical analysis was performed using Student’s t-test for continuous variables and Chi-square test for categorical variables, with p<0.05 considered significant.   Results: Sublay repair was associated with significantly lower VAS scores at 24 hours (5.2 ± 1.3 vs 6.4 ± 1.5, p=0.01) and 48 hours (3.8 ± 1.1 vs 4.9 ± 1.4, p=0.02). At 1 week and 1 month, pain remained lower in sublay patients but differences were not statistically significant. At 3 months, SF-36 showed significantly better scores in physical functioning (78.5 ± 8.3 vs 71.2 ± 7.9, p=0.01) and general health (74.6 ± 7.4 vs 68.1 ± 8.1, p=0.02) in the sublay group. Other domains including mental health and role emotional did not differ significantly. Conclusion: Sublay mesh repair results in reduced early postoperative pain and improved physical aspects of quality of life compared with onlay repair, underlining its advantage not only in surgical outcomes but also in patient-centered recovery.