A Comparative Study of Open Onlay versus Retro-Rectus Sublay Mesh Repair for Ventral Incisional Hernia: One-Year Clinical and Surgical Outcomes

Background: Ventral incisional hernia repair remains surgically challenging, and optimal mesh placement technique is debated due to differences in operative complexity, postoperative morbidity, and recurrence outcomes. Objective: To compare one-year clinical, surgical, and complication-related outcomes between open onlay and retro-rectus sublay mesh repair techniques for ventral incisional hernia. Methods: This quasi-experimental study was conducted at the Department of Surgery, Rajshahi Medical College Hospital, Bangladesh, from July 2022 to June 2024. Sixty patients were allocated equally to onlay (n=30) and sublay (n=30) mesh repair groups. Baseline demographics, operative parameters, postoperative complications, hospital stay, and recurrence were analyzed using appropriate statistical tests with significance set at p<0.05. Results: Baseline characteristics were comparable between groups (mean age: sublay 37.12 ± 7.04 vs onlay 39.52 ± 6.45 years; p>0.05). Mean operative time was significantly longer in the sublay group (127.4 ± 15.76 vs 115.71 ± 11.90 minutes; p=0.02). Sublay repair demonstrated shorter postoperative hospital stay (10.65 ± 5.12 vs 14.24 ± 5.07 days; p=0.02). Seroma (6.6% vs 43.3%), wound infection (6.6% vs 30.0%), mesh extraction (0% vs 10.0%), and sepsis (3.3% vs 13.3%) were significantly lower in the sublay group (p<0.05). Recurrence rates remained low and comparable (6.6% vs 3.3%; p>0.05). Conclusion: Retro-rectus sublay mesh repair offers superior postoperative recovery and fewer wound-related complications despite longer operative time, supporting its preference for ventral incisional hernia repair.