Laparoscopic Intraperitoneal Onlay Mesh Repair versus Open Sublay Mesh Repair of Incisional Hernia: A Prospective Comparative Study from the Bundelkhand Region of India

Background: Incisional hernia develops in 10–20% of patients after laparotomy. Laparoscopic intraperitoneal onlay mesh (IPOM) repair may cause fewer wound problems than open repair, but data from public-sector hospitals in central India are scarce. Objective: To compare laparoscopic IPOM repair with open sublay mesh repair of incisional hernia for operative outcomes, recovery and early complications. Methods: In this prospective, non-randomised study (March 2024–February 2025) at a public teaching hospital in Jhansi, 80 patients with uncomplicated incisional hernia and a 2–5 cm fascial defect underwent laparoscopic IPOM (n=40) or open sublay repair (n=40). Operative time, blood loss, conversion, pain (visual analogue scale, VAS) on days 1–5, hospital stay, return to routine activity and wound complications were compared. Results: Laparoscopic repair was associated with less blood loss (36.2 vs. 80.0 mL), lower pain on all five days (day-1 VAS 5.55 vs. 7.12), shorter hospital stay (3.0 vs. 5.0 days) and earlier return to activity (11.3 vs. 15.1 days) (all p<0.001). These advantages persisted after excluding ASA III patients, whereas the shorter operative time (51.6 vs. 60.1 min; p=0.002) did not. Four laparoscopic cases (10%) were converted to open repair. Wound complications occurred in 27.5% vs. 42.5% (p=0.24); both mesh infections followed open repair. Conclusion: For incisional hernias with a 2–5 cm defect, laparoscopic IPOM repair offers less pain, a shorter hospital stay and faster recovery than open sublay repair, without early mesh-related complications. Randomised trials with long-term follow-up are needed.