Pre-peritoneal versus on-lay meshplasty in incisional hernia repair

Background: An incisional hernia is a bulge or protrusion that occurs near or directly along a prior abdominal surgical incision. Various surgical techniques including Open tissue repair, double breasting, darning, open and laparoscopic meshplasty have been used to repair the incisional hernias. In this era, we have selected topic ‘Pre-peritoneal versus on-lay meshplasty in incisional hernia repair’ to focus on advantage and disadvantage of two methods of hernia repair and to provide information regarding indications and benefits of one over another. Material and methods: 77 cases of ventral hernia were taken in On-lay and Pre-peritoneal group. Observations were made with regards to duration and ease of operation, wound complications, hospital stay, morbidity and recurrence. Study profile: group (A): On-lay meshplasty (The prosthetic mesh placed between the subcutaneous tissues of the abdominal wall and the anterior rectus sheath e.g. on the rectus sheath) group (B): Pre-peritoneal meshplasty (The prosthetic mesh placed in the pre-peritoneal plane e.g. Sub lay/ Retro-muscular plane). Results: Mean age in On-lay group is 47.96 year. While in Pre-peritoneal group mean age is 48.66 year. Results showing pain is not making difference between two methods in post operative period 6th day onwards. The duration of hospital stay was comparable and mean duration in On-lay is 3.51 day and in Pre-peritoneal is 3.9 day. In both this method, out of 50, in 37 patients 15X15 cm prolene mesh (cost Rs. 1800) was used and in 13 patients 10X10 cm prolene mesh (cost Rs. 1000) was used. In both cases hospital spend around Rs. 1500 ? 2000 average on hospital stay, drugs, food. General anesthesia used cost around Rs.2000 each patient as compare to spinal anesthesia used in other which cost for Rs. 250 each patient. It showed that Pre-peritoneal method required more time than On-lay. In this study, 6/33 patients develops seroma in on-lay method, while 1/44 patients develops seroma in Pre-peritoneal method in post operative period. P value <0.05, the difference is statistically significant. In this study, 2/33 patients develops wound infection in on-lay method in post operative period, while 0/44 patients develops wound infection in pre-peritoneal method in post operative period. P value <0.05, the difference is statistically significant. Conclusion: In view of less post-operative complications like seroma, wound infection, mesh removal and early returns to routine work and less recurrence; pre-peritoneal meshplasty is better repair for incisional hernia compared to on-lay meshplasty.