Ventral Abdominal Wall Hernioplasty: Insights into Intraperitoneal Onlay Mesh Vs Sublay Technique, A Retrospective Cross-Sectional Study
DOI:
https://doi.org/10.36283/ziun-pjmd15-1/014Keywords:
Ventral Hernia, Hernioplasty, Surgical Mesh, Laparoscopy, Postoperative PainAbstract
Background: Ventral abdominal wall hernia represents a common surgical problem that is linked to morbidity, prolonged recovery duration, and high costs of healthcare. The purpose of this study was to compare the outcome of perioperative, postoperative pain, and complication rate in open sublay versus laparoscopic IPOM repair in a tertiary care hospital.
Methods: This retrospective cross-sectional study (March to November 2025) comprised of 120 patients underwent ventral hernia repair, were divided into two groups (Group A (open sublay, n=60), and Group B (laparoscopic/IPOM, n=60)). Demographic data, comorbid data, operative data, mesh size, use of analgesics and antibiotics, drain data, hospitalization, Visual Analogue Scale (VAS) pain scores and postoperative complications were recorded. Independent t-tests and the Fisher exact test were used as statistical tests, with the p-value of less than 0.05 being regarded as significant.
Results: Laparoscopic/IPOM group demonstrated better results in the time spent in operations (46.35 ± 5.7 vs. 59.53 ± 8.4 min, p=0.001) and days in the hospital (3.0 ± 1.0 vs. 5.0 ± 2.0 days, p<0.001). The levels of postoperative pain were also reduced and 86% of the patients had mild pain (VAS <3), as compared to 33% in the open group (p=0.0001). There were also less analgesics and drain requirements in the laparoscopic group.
Conclusion: Laparoscopic/IPOM repair is the most effective in terms of faster recovery, less postoperative pain, less perioperative burden, and safety equivalent than that of open sublay repair. These results promote laparoscopy repair as a convenient method in the management of ventral hernias.
References
1. Kalyan M, Rathore SS, Verma V, Sharma S, Choudhary M, Irshad I, et al. Laparoscopic Versus Open Ventral Hernia Repair: Experience at a Tertiary Care Center in Western Rajasthan. Cureus. 2022 Jul 26;14(7):e27279. doi: 10.7759/cureus.27279.
2. Pereira C, Rai R. Open Versus Laparoscopic Ventral Hernia Repair: A Randomized Clinical Trial. Cureus. 2021 Dec 17;13(12):e20490. doi: 10.7759/cureus.20490.
3. Lodha M, Patel D, Badkur M, Meena SP, Puranik A, Chaudhary R, et al. Assessment of Quality of Life After Ventral Hernia Repair: A Prospective Observational Study at a Tertiary Care Centre. Cureus. 2022 Jun 20;14(6):e26136. doi: 10.7759/cureus.26136.
4. Loh C, Tan L, Wijerathne S, Lee J, Wai L, Parameswaran R, et al. Open versus laparoscopic intraperitoneal on-lay mesh repair: A comparison of outcomes in small ventral hernia. Asian J Surg. 2023 Feb;46(2):712-717. doi: 10.1016/j.asjsur.2022.06.153.
5. Bellido Luque J, Gomez Rosado JC, Bellido Luque A, Gomez Menchero J, Suarez Grau JM, Sanchez Matamoros I, et al. Endoscopic retromuscular technique (eTEP) vs conventional laparoscopic ventral or incisional hernia repair with defect closure (IPOM +) for midline hernias. A case-control study. Hernia. 2021 Aug;25(4):1061-1070. doi: 10.1007/s10029-021-02373-0.
6. Li J, Wang Y, Wu L. The Comparison of eTEP and IPOM in Ventral and Incisional Hernia Repair: A Systematic Review and Meta-analysis. Surg Laparosc Endosc Percutan Tech. 2022 Jan 17;32(2):252-258. doi: 10.1097/SLE.0000000000001035.
7. Martins MR, Santos-Sousa H, do Vale MA, Bouça-Machado R, Barbosa E, Sousa-Pinto B. Comparison between the open and the laparoscopic approach in the primary ventral hernia repair: a systematic review and meta-analysis. Langenbecks Arch Surg. 2024 Feb 3;409(1):52. doi: 10.1007/s00423-024-03241-y.
8. Shaukat W, Yar MA, Ali Z, Aslam T, Hussain S, Yasmeen Q, et al. A Meta-Analysis Comparing Sublay and Onlay Mesh Repair in Incisional Hernia Surgery Based on Surgical Outcomes. Cureus. 2025 Jul 8;17(7):e87541. doi: 10.7759/cureus.87541.
9. Elhadidi A, Shetiwy M, Al-Katary M. Comparative analysis of laparoscopic, retro-muscular, and open mesh repair techniques for ventral and incisional hernias: a comprehensive review and meta-analysis. Updates Surg. 2025 Jan;77(1):217-229. doi: 10.1007/s13304-024-02049-1.
10. Shah DK, Patel SJ, Chaudhary SR, Desai NR. Comparative study of onlay versus sublay mesh repair in the management of ventral hernias. Updates Surg. 2023 Oct;75(7):1991-1996. doi: 10.1007/s13304-023-01532-5.
11. Bhardwaj R, Agrawal U, Vashist P, Manna S. Determination of sample size for various study designs in medical research: A practical primer. J Family Med Prim Care. 2024 Jul;13(7):2555-2561. doi: 10.4103/jfmpc.jfmpc_1675_23.
12. Deshpande GA, Tirpude B, Bhanarkar H, Akulwar V, Kodape G, Gajbhiye R. Prospective, observational study of intraperitoneal onlay mesh repair with defect closure versus SCOLA for primary ventral hernia. J Minim Access Surg. 2024 Oct 1;20(4):397-402. doi: 10.4103/jmas.jmas_223_23.
13. Gómez-Menchero J, Balla A, García Moreno JL, Gila Bohorquez A, Bellido-Luque JA, Morales-Conde S. Laparoscopic intracorporeal rectus aponeuroplasty (LIRA) technique versus intraperitoneal onlay mesh (IPOM plus) for ventral hernia repair: a comparative analysis. Hernia. 2024 Feb;28(1):167-177. doi: 10.1007/s10029-023-02858-0.
14. Ali F, Sandblom G, Wikner A, Wallin G. Laparoscopic ventral and incisional hernia repair using intraperitoneal onlay mesh with peritoneal bridging. Hernia. 2022 Apr;26(2):635-646. doi: 10.1007/s10029-021-02502-9.
15. Pizza F, D'Antonio D, Lucido FS, Brusciano L, Mongardini FM, Dell'Isola C, et al. IPOM plus versus IPOM standard in incisional hernia repair: results of a prospective multicenter trial. Hernia. 2023 Jun;27(3):695-704. doi: 10.1007/s10029-023-02802-2. Epub 2023 May 7. PMID: 37149818.
16. Maskal SM, Ellis RC, Mali O, Lau B, Messer N, Zheng X, et al. Long-term mesh-related complications from minimally invasive intraperitoneal onlay mesh for small to medium-sized ventral hernias. Surg Endosc. 2024 Apr;38(4):2019-2026. doi: 10.1007/s00464-024-10716-y. Epub 2024 Feb 29. PMID: 38424284; PMCID: PMC10978620.
17. Slavu IM, Filipoiu F, Munteanu O, Tulin R, Ursuț B, Dogaru IA, et al. Laparoscopic Intraperitoneal Onlay Mesh (IPOM) in the Treatment of Ventral Hernias: Technique Discussion Points. Cureus. 2024 May 27;16(5):e61199. doi: 10.7759/cureus.61199.
18. Kumar N, Palanisamy NV, Parthasarathi R, Sabnis SC, Nayak SK, Palanivelu C. A comparative prospective study of short-term outcomes of extended view totally extraperitoneal (e-TEP) repair versus laparoscopic intraperitoneal on lay mesh (IPOM) plus repair for ventral hernia. Surg Endosc. 2021 Sep;35(9):5072-5077. doi: 10.1007/s00464-020-07990-x.
19. Szepietowska K, Troka M, Lichodziejewska-Niemierko M, Chmielewski M, Lubowiecka I. Full-field in vivo experimental study of the strains of a breathing human abdominal wall with intra-abdominal pressure variation. J Mech Behav Biomed Mater. 2023 Nov;147:106148. doi: 10.1016/j.jmbbm.2023.106148.
20. Beckers Perletti L, Spoelders F, Berrevoet F. Association between surgical hernia repair techniques and the incidence of seroma: a systematic review and meta-analysis of randomized controlled trials. Hernia. 2022 Feb;26(1):3-15. doi: 10.1007/s10029-021-02531-4.
21. Saikumar I, Kshirsagar V, Dnyanmote A, Tirmanwar V, Agarwal S. A Comparative Study of Open versus Laparoscopic Sublay Repair for Ventral Hernia. Ann Afr Med. 2025 Sep 9. French, English. doi: 10.4103/aam.aam_206_25.
22. Padekar H, Ambore V, Dutt A, Ansari K, Bhondve S, Dashputra AV, et al. A prospective observational study on intraperitoneal mesh repair for small ventral hernias: Why open prevails over laparoscopic approach. J Minim Access Surg. 2025 Oct 1;21(4):359-364. doi: 10.4103/jmas.jmas_247_24.
23. Lal P, Kumar J, Lal T, Vindal A. Comparison of extended view totally extraperitoneal with intraperitoneal onlay mesh for primary ventral hernia surgery: A randomised controlled study from a tertiary university hospital. J Minim Access Surg. 2025 Jul 22. doi: 10.4103/jmas.jmas_52_25.
24. Elhadidi A, Shetiwy M, Al-Katary M. Comparative analysis of laparoscopic, retro-muscular, and open mesh repair techniques for ventral and incisional hernias: a comprehensive review and meta-analysis. Updates Surg. 2025 Jan;77(1):217-229. doi: 10.1007/s13304-024-02049-1.
25. Chue KM, Kabir T, Tan CC, Tan JTH, Kam JH, Wong WK, et al. Laparoscopic versus open mesh repairs for small-sized ventral and incisional hernias: a propensity score analysis of a retrospective cohort of patients. Surg Endosc. 2025 Apr;39(4):2579-2587. doi: 10.1007/s00464-025-11627-2. Epub 2025 Mar 5. PMID: 40045059.
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