A Prospective Controlled Study For Comparision Between Onlay Versus Sublay Mesh Repair In Ventral Hernias In Our Population

A Ventral Hernia is defined by a protrusion through the anterior abdominal wall fascia

• These defects can be characterised by spontaneous or acquired or by their location on the abdominal wall.

 Ventral hernia is commonly encountered in surgical practice.  An estimated one-quarter of all individuals are either born with or will develop a ventral hernia in their lifetimes. It is a common surgical problem and refers to fascial defect of the anterolateral parietal abdominal wall fascia and muscles, through which intermittent or continuous protrusion of intra-abdominal or preperitoneal contents occurs.

Types of ventral Hernia:These hernias have various types that can be categorized into either de novo or incisionalwhich occurs at the site of a pervious surgical scar. Both types have two subtypes, lateral and midline ventral hernias .

Incisional (Acquired) Hernia

Epigastric Hernia

Umbilical Hernia

Para-umbilical Hernia

Hypogastric Hernia

Incidence of incisional hernias is 15-20% of all abdominal wall hernias and umbilical and epigastric hernias constitute 10% of hernias.

Female to male ratio for incisional hernias is 2:1.

Patient related factors  linked to ventral hernia formation include obesity, older age, male gender, sleep apnea, emphysema, and prostatism.

Poor wound healing or wound infection, poor surgical techniques can lead to incisional hernias.

Despite advances in surgical technique and prosthetic technologies, the risks for recurrence and infection are high following the repair of ventral hernias.

 High-quality data suggest that all ventral hernia repairs should be reinforced with prosthetic repair materials.

The current standard for reinforced hernia repair is synthetic mesh, which can reduce the risk for recurrence in many patients.

The most 2 positions for mesh application in open repair are the onlay repair where the mesh is positioned over the anterior rectus sheath, and the sublay (retromuscular) repair, the more commonly known as stoppa technique .

Permanent synthetic mesh can pose a serious clinical problem in the setting of infection . However, it is the understanding of the abdominal wall that has made complex procedures possible including myofascial and musculocutaneous advancement flaps through component separation and muscular release.

These advancements have enabled surgeons the technical ability to use prosthetics in different manners and grant closure of abdominal defects that were considered impossible in the past.