Clinical Study Of Onlay Versus Sublay Mesh Repair In Incisional Hernia Surgery

Objective: Investigate the clinical effect of open surgery for abdominal incisional hernia with Onlay mesh repair and Sublay mesh repair(or preperitoneal repair).Methods: Retrospectively analyze the clinical data of 76 patients with abdominal incisional hernia repaired by open surgery in the First Affiliated Hospital of Fujian Medical University from January 2010 to January 2017.Among them,33 cases were treated with Onlay mesh repair(Onlay method),and 43 cases were treated with Sublay mesh repair(or preperitoneal repair).Observe the curative effects of the 2 methods.Results: There was no significant difference between the two groups in operation time,postoperative hospital stay,total cost of hospitalization(P>0.05).7 patients of Onlay group occurred incision infection,the incidence was 21.21%,1 patient of Sublay group occurred incision infection,the incidence was 2.33%,the difference was statistically significant(P<0.05).Incision of blood or effusion,postoperative intestinal fistula,pulmonary infection,intestinal obstruction and other complications had no significant difference between two groups(P>0.05).Followed up for 3-82 months,with an average of 36.61 ±17.95 months,5 patients of Onlay group recurrence(15.15%),with an average of 8.80 ±2.86 months;3 patients of Sublay group recurrence(6.97%),with an average of 24.33±5.31 months,The average postoperative recurrence time in SR group >OR group,the difference was statistically significant(P<0.05).During the follow-up of 1 year,4 patients of OR group recurrent(12.12%),no patient of SR group recurrent(0%),the difference was statistically significant(P<0.05);During the follow-up of 2 years,5 patients of OR group recurrent(15.15%),2 patients of SR group recurrent(4.65%),the difference was not statistically significant(P>0.05);During the follow-up of 3 years,5 patients of OR group recurrent(15.15%),3 patients of SR group recurrent(6.97%),the difference was not statistically significant(P>0.05).Conclusion: Abdominal incisional hernia patients with Onlay mesh repair(Onlay method)and Sublay mesh repair(or preperitoneal repair)(Sublay method)for treatment of abdominal incisional hernia has significant clinical efficacy.They are similar in terms of the operation time,postoperative hospital stay,total cost of hospitalization,blood volume or effusion,incision fistula,pulmonary infection and intestinal obstruction,Sublay mesh repair incision infection rate and recurrence in short-term rate were lower compared with Onlay mesh repair,however,the long-term recurrence rate tends to be similar.Therefore,different surgical procedures were selected according to the general situation of patients.