AI Article Synopsis
- The sublay technique for incisional hernia repair shows advantages over the onlay technique in meta-analyses and systematic reviews, though onlay may still be useful in certain cases.
- Unadjusted analysis of data from the Herniamed Registry found onlay operations tended to be performed more frequently for smaller defects and in women, but when propensity score matching was applied, outcomes between the two techniques were comparable.
- In specific patient groups with small and lateral incisional hernias and more women, the results suggest that both sublay and onlay techniques yield similar outcomes within one year post-operation.
Article Abstract
Introduction: In meta-analyses and systematic reviews, clear advantages have been identified for the sublay versus onlay technique for treatment of incisional hernias. Nonetheless, an expert panel has noted that the onlay mesh location may be useful in certain settings.
Materials And Methods: First, unadjusted analysis of data from the Herniamed Registry was performed to compare 6797 sublay operations with 1024 onlay operations for repair of incisional hernias. Then, using propensity score matching to account for the influence of variables age, gender, ASA score, BMI, risk factors, preoperative pain, defect size, and defect localization, 1016 pairs were formed and compared with each other.
Results: Unadjusted analysis revealed that the onlay operation was used significantly more often for small defects, lateral defect localization, and in women. After comparing the propensity score-matched pairs, no significant difference was found between the sublay and onlay technique in the outcome criteria intra- and postoperative complications, general complications, complication-related reoperations, pain at rest, pain on exertion, chronic pain requiring treatment, and recurrence on 1-year follow-up. But that was true only for this carefully selected patient collective.
Conclusion: In a selected patient collective with small and lateral incisional hernias and with a large proportion of women, outcomes obtained for the onlay and sublay techniques do not differ significantly.
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| http://dx.doi.org/10.1007/s00268-019-04980-6 | DOI Listing |
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