Shaukat Wishal, Yar Malik Asfand, Ali Zulfiqar, Aslam Tahir, Hussain Saud, Yasmeen Qamar, Abbasi Kamran Hyder, Shiraz Mohammad
General Surgery, University Hospitals Birmingham, Birmingham, GBR.
Acute Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham (UHB) National Health Services (NHS) Foundation Trust, Birmingham, GBR.
Cureus. 2025 Jul 8;17(7):e87541. doi: 10.7759/cureus.87541. eCollection 2025 Jul.
Incisional hernia is a common surgical complication that often requires mesh-based repair. Among the various techniques, sublay (retrorectus) and onlay mesh placements are frequently employed, but their relative effectiveness in terms of surgical outcomes remains debated. This meta-analysis aimed to compare sublay and onlay mesh repair techniques in incisional hernia surgery based on key postoperative outcomes. A systematic search was conducted across PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, ProQuest, and Google Scholar for studies published in English between January 2010 and March 2025. Eligible studies included randomized controlled trials and prospective comparative studies directly comparing sublay and onlay mesh repair techniques and reporting on at least one predefined surgical outcome. Six studies involving a total of 468 patients were included in the analysis. Primary outcomes assessed included hernia recurrence, postoperative complications, surgical site infection (SSI), and seroma formation. Secondary outcomes included operative time and length of hospital stay. Data were analyzed using a random-effects model with odds ratios (OR) and mean differences (MD) reported along with 95% confidence intervals (CI). The meta-analysis revealed that sublay mesh repair was consistently associated with lower hernia recurrence rates, though the differences did not reach a statistical significance. Sublay repair also demonstrated significantly fewer postoperative complications in multiple studies, particularly in terms of reduced seroma formation and SSI. Furthermore, hospital stay was significantly shorter in the sublay group in two of the three studies reporting this outcome. Onlay repair, however, was associated with a shorter operative time. In conclusion, sublay mesh repair offers superior outcomes in terms of recurrence, complications, seroma, and hospital stay, suggesting it as the preferred approach for incisional hernia repair in appropriate clinical settings.
切口疝是一种常见的手术并发症，通常需要采用基于补片的修复方法。在各种技术中，腹膜前（腹直肌后）和外置补片放置术经常被采用，但它们在手术效果方面的相对有效性仍存在争议。这项荟萃分析旨在根据关键的术后结果比较切口疝手术中腹膜前和外置补片修复技术。在PubMed、Cochrane对照试验中心注册库（CENTRAL）、Scopus、ProQuest和谷歌学术上进行了系统检索，以查找2010年1月至2025年3月期间发表的英文研究。符合条件的研究包括随机对照试验和直接比较腹膜前和外置补片修复技术并报告至少一项预定义手术结果的前瞻性比较研究。分析纳入了6项研究，共468例患者。评估的主要结果包括疝复发、术后并发症、手术部位感染（SSI）和血清肿形成。次要结果包括手术时间和住院时间。使用随机效应模型进行数据分析，报告比值比（OR）和平均差（MD）以及95%置信区间（CI）。荟萃分析显示，腹膜前补片修复与较低的疝复发率始终相关，尽管差异未达到统计学意义。在多项研究中，腹膜前修复的术后并发症也明显较少，特别是在血清肿形成和SSI减少方面。此外，在报告这一结果的三项研究中的两项中，腹膜前组的住院时间明显更短。然而，外置补片修复的手术时间较短。总之，腹膜前补片修复在复发、并发症、血清肿和住院时间方面具有更好的效果，表明在适当的临床环境中它是切口疝修复的首选方法。
