Properitoneal (Sublay) Versus Prefascial (Onlay) Prosthetic Mesh Placement Used in the Repair of Incisional Hernias

Background: Incisional hernias develop in up to 13% of laparotomy incisions. Recurrence after surgical treatment may be high up to 46% and it is at least twice as frequent following open suture repair than after mesh repair. Aim of Work: Our aim is to compare the early results of two different methods of prosthetic mesh placement used in the repair of ventral hernias, namely: pro-peritoneal and on-lay subcutaneous mesh application. Patients and Methods: The study consists of a total of 46 patients with different types of incisional hernias admitted at Kasr El-Aini University Hospital from January 2004 to January 2006. Patients were randomly divided into 2 groups; Group I consists of 22 patients were subjected to pro-peritoneal mesh repair with modification of method of fixation using 5mm laparoscopic trocar. Group II consists of 24 patients were subjected to on-lay mesh repair. Results: Twenty two patients were enrolled in Group I with pro-peritoneal mesh repair with age range between 27 to 67 years old, only 2 of them males. Median defect size is 9cm. Average operative time was 133 (63-209) minutes with blood loss 227 (102-408) cc. The drain was kept for 3 days in average. Average seroma drainage was 26 (10-36) cc/day. Ultrasound detects seroma in 2 cases on follow-up. Only 2 cases show staph.albus on culture with no other complications. Patients start mobilization after 4-24 hours with overall hospital stay of 2-6 days. Group II includes 24 patients with on-lay mesh repair with age range between 25 to 69 years old, three are males and 21 are female. Median defect size is 13cm. Average operative time was 170 (76-256) minutes with blood loss 649 (218-1354) cc. The drain was kept for 8 days in average seroma drainage was 92 (48-153) cc/day. Ultrasound detects seroma in 6 cases on follow-up. On culture one cases show ecoli, and 4 cases with staph.albus. No other complica-tions were detected. Patients start mobilization after 19-29 hours with overall hospital stay of 5-12 days. Conclusions: The pro-peritoneal approach for the repair of incisional ventral hernia has better out come than on-lay mesh replacement regarding operative time, intraoperative blood loss and seroma formation.