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Ventral hernias are the protrusion of intra-abdominal contents through the defect in the anterior abdominal wall. These defects may be congenital or acquired. Acquired hernias may be traumatic or iatrogenic. Materials and Methods: This is a randomised double blind prospective study which was conducted in the surgical department of Narayana medical college and hospital. A total of 80 cases were included in this study. Of these, 40 cases were operated by the onlay mesh repair method and 40 by sublay mesh repair. In this study neither the patient nor the surgeon knows about the type of the procedure being executed on them. All the patients who approach in the OPD with the abdominal wall hernias are being asked to pick up the slip on which the procedure name was written. Results: In our study out of the total 80 case operated for ventral hernias 40 were operated by Onlay repair and 40 cases by Sublay repair and both these groups were sub grouped on the basis of presence or absence of Seroma, patient satisfaction in terms of cosmetic as well as comfort and recurrence. When we compared the above said parameters between the two procedures. Out of the 40 patients operated by the onlay technique 16 patients developed seroma out of these 16 patients who developed seroma 4 patients got infected and which was well controlled by antibiotic coverage based on culture and sensitivity report. Around 21 patients were not satisfied in terms of comfort due to wound collection, increased pain and infection. Around 22 patients were reported puckering of the scar, adherence of the skin to the mesh and feeling foreign body sensation under the skin. Observations in the sublay mesh repair showed that only 1 patient developed seroma and 4 patients reported discomfort due to subcutaneous collection, 2 patients were reported cosmetic compromise due to tissue induration and there was no recurrences and infection. Conclusion: In our study we concluded that sublay mesh repair is superior to onlay mesh repair in terms of seroma, cosmetic, comfort, recurrence and infection rates.Even though onlay mesh repair is most widely used and easy to do the procedure but associated with higher incidence of above said parameters.

A comparative study of Onlay versus Sublay mesh repair in ventral hernias