Ventral hernias meshplasty: does mesh-implantation site affect the outcome?

Background
Although meshplasty has been established as the gold standard for ventral hernia repair, there is debate on the mesh-placement site. This study tried to compare onlay mesh placement with sublay meshplasty in terms of outcome.
Patients and methods
This is a prospective cross-armed study including 65 patients suffering from ventral hernias who were electively admitted to Sohag University Hospital between October 2013 and November 2014. Patients were randomly allocated to two groups: group A included 32 patients who underwent onlay meshplasty and group B included 33 patients who underwent sublay meshplasty. Patients were evaluated with respect to the outcome of both techniques and statistically analyzed after 2 years of follow-up.
Results
Regarding the operative and postoperative outcomes, the operative time was longer in group B, which was highly significant (≤0.001). Postoperative wound pain was less in group B, which was significant (=0.018). Regarding early postoperative complications, postoperative superficial infection (=0.050) and hematoma formation (=0.033) were significantly less in group B. Seroma formation was also significantly less in group B (=0.050). The mean duration of postoperative hospital stay was shorter in group B and this was highly significant (<0.001). During follow-up, recurrence was seen in group A, which was statistically significant (=0.015).
Conclusion
Sublay meshplasty, when feasible, is superior to onlay mesh placement for open ventral hernia repair.