Sublay Versus Intraperitoneal Onlay Mesh Repair in Large Ventral Hernias

In general surgery, the management of ventral abdominal hernias characterized by the protrusion of tissue through weaknesses in the abdominal wall presents significant challenges, particularly when dealing with large ventral hernias, defined as those ≥10 cm or those under tension if closed primarily.

Incisional hernias, a specific subset of ventral hernias, add to the complexity of repair.

While the Intraperitoneal Onlay Mesh (IPOM) technique is noted for its reduced surgical and postoperative complications and lower reoperation rates, it also suffers from high costs, limited availability of specialized meshes like dynamesh, and increased intraoperative complications.

Alternatively, the modified open sublay technique, which employs a primary retro-muscular fascial repair and uses an affordable polypropylene mesh, offers a promising and cost effective solution with potential for a tension free repair.

This thesis aims to evaluate and compare these techniques to identify the most effective approach for large ventral hernia repair, balancing surgical outcomes, and complication rates.

Inclusion criteria

• Age (18-70) years, both sexes.
• Fitness for surgery.
• Patients with uncomplicated ventral hernia.
• Large anterior abdominal wall defect.

Exclusion criteria

• Patients don't fit for general anesthesia due to sever co-morbidity.
• Patients with complicated ventral hernia.
• Patient refusal of surgical intervention.
• History of bleeding disorders.
• Pregnancy in female patients