Comparison of Efficacy and Safety in Sublay versus Onlay Mesh Repair for Para-Umbilical Hernia: A Randomized Controlled Trial

Main Article Content

Yaseen Babar
Monawar Shah
Raza Ullah


Background: Ventral hernias, either spontaneous or post-surgical, represent a significant challenge in surgical practice. The recurrence rates after primary tissue repair, especially in larger hernias, necessitate the use of tension-free mesh repairs. However, the choice between onlay and sublay mesh repair methods remains a subject of debate, with each technique having its own set of advantages and drawbacks.

Objective: The study aimed to compare the efficacy and safety of sublay versus onlay mesh repair techniques in the treatment of ventral hernias, with a focus on postoperative complications, pain, and treatment success rates.

Methods: This randomized controlled trial was conducted from May 2023 to October 2023 at multiple surgical centers. It involved 120 patients, aged 18 to 70 years, undergoing ventral hernia repair. Patients were randomly allocated into two groups: Group A (60 patients) receiving onlay mesh repair and Group B (60 patients) receiving sublay mesh repair. The study assessed postoperative complications, including seroma, wound infection, and pain using the Visual Analogue Scale (VAS), as well as overall treatment efficacy. Data were analyzed using SPSS version 25.0, with a p-value of less than 0.05 considered statistically significant.

Results: The mean age in Group A was 40.90±11.56 years, and in Group B, 40.55±11.63 years. Group A comprised 41.7% males and 58.3% females, while Group B had 46.7% males and 53.3% females. In Group A, seroma developed in 10%, wound infection in 15%, and postoperative pain in 18.3% of patients. Group B reported seroma in 3.3%, wound infection in 3.3%, and postoperative pain in 6.7%. The effectiveness of the treatment was 80% in Group A and 93.3% in Group B, with a notable difference in complication rates and success between the groups.

Conclusion: The sublay mesh repair technique demonstrated superior outcomes in terms of lower complication rates and higher treatment efficacy compared to the onlay method. This suggests that the sublay approach may be more advantageous for ventral hernia repair, offering better patient outcomes with fewer postoperative complications.

Article Details

How to Cite
Babar, Y., Shah, M., & Ullah, R. (2024). Comparison of Efficacy and Safety in Sublay versus Onlay Mesh Repair for Para-Umbilical Hernia: A Randomized Controlled Trial. Journal of Health and Rehabilitation Research, 4(1), 19–22.
Author Biographies

Yaseen Babar, MRHSM Hospital Pabbi Nowshera Khyber Pakhtunkhwa.

Consultant General Surgeon, Department of General Surgery

Monawar Shah, DHQ Ghallani Mohmand Khyber Pakhtunkhwa.

Consultant General Surgeon, Department of A&E.

Raza Ullah, Cat C Hospital Tangi Charsadda Khyber Pakhtunkhwa.

Consultant Surgeon, Department of General Surgery


Ismaeil DA. Mesh repair of paraumblical hernia, outcome of 58 cases. Ann Med Surg. 2018;30(7):28-31.

Kaufmann R, Halm JA, Eker HH, Klitsie PJ, Nieuwenhuizen J, van Geldere D, et al. Mesh versus suture repair of umbilical hernia in adults: a randomised, double-blind, controlled, multicentre trial. Lancet. 2018;391(10123):860-9.

Raghuveer MN, Muralidhar S, Shetty H, Veena V. Onlay versus sublay mesh repair for ventral hernia. Int Surg J. 2018;5(3):823-6.

Iljin A, Antoszewski B, Zieliński T, Skulimowski A, Szymański D, Strzelczyk J. Sublay or onlay incisional hernia repair along with abdominoplasty: which is better? Long-term results. Hernia. 2019;23(200):757-65.

Ahmed M, Mehboob M. Comparisons of onlay versus sublay mesh fixation technique in ventral abdominal wall incisional hernia repair. J Coll Physicians Surg Pak. 2019;29(9):819-22.

Blatnik JA, Michael Brunt L. Controversies and techniques in the repair of abdominal wall hernias. J Gastrointest Surg. 2019;23(107):837-45.

Kokotovic D, Bisgaard T, Helgstrand F. Long-term recurrence and complications associated with elective incisional hernia repair. JAMA. 2016;316(15):1575-82.

Li J, Ji Z, Zhang W, Li L. The comparison of lightweight mesh and standard mesh in incisional hernia repair with the open sublay technique: the results of a meta-analysis. Surg Laparosc Endosc Percutan Tech. 2015;25(3):238-44.

Khawaja FG, Mahmood K, Gul UJ, Aslam A, Saeed F, Nayyar A. Comparison of Sublay and Onlay Mesh Repair in Terms of Post-Operative Complications. Pak. Armed Forces Med J. 2023;73(3):686-9.

Krpata DM, Petro CC, Prabhu AS, Tastaldi L, Zolin S, Fafaj A, et al. Effect of hernia mesh weights on postoperative patient-related and clinical outcomes after open ventral hernia repair: a randomized clinical trial. JAMA . 2021;156(12):1085-92.

Langbach O, Bukholm I, Benth JŠ, Røkke O. Long term recurrence, pain and patient satisfaction after ventral hernia mesh repair. World J Gastrointest Surg. 2015;7(12):384-9.

Kumar AR, Chandrakumar SV, Vijayalaxmi A, Sivaiah T, Ramana NV. Incisional hernia-onlay vs sublay mesh hernioplasty. J Evol Med Dent. 2015;4(35):6040-6.

Al-Tai AH. Evaluation of" sublay" versus" onlay" mesh hernioplasty in ventral hernial repair. J Pharm Sci. 2019;11(4):1313-8.

Naveen PG, Khan A. Laparoscopic repairs for anterior abdominal wall hernias. Int Surg J. 2019;6(2):349-54.

Holihan JL, Nguyen DH, Nguyen MT, Mo J, Kao LS, Liang MK. Mesh location in open ventral hernia repair: a systematic review and network meta-analysis. World journal of surgery. 2016;40(1):89-99.

Poulose BK, Shelton J, Phillips S, Moore D, Nealon W, Penson D, et al. Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia. 2012; 16(2): 179- 83.

Muysoms F, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, et al. Classification of primary and incisional abdominal wall hernias. Hernia. 2009; 13(4):407-14.

Afridi SP, Siddiqui RA, Rajput A. Complications of Onlay and Sublay Mesh Plasty in Ventral Abdominal Hernia Repair. J Surg Pak. 2015;20(2):48-51.

Bessa S, El-Gendi A, Ghazal A-H, Al-Fayoumi T. Comparison between the short-term results of onlay and sublay mesh placement in the management of uncomplicated para-umbilical hernia: a prospective randomized study. Hernia. 2015;19(1):141-6.

Ismail M, Khan S, Ali M, Bayazeed IA, Ali A. Efficacy and safety between sublay and onlay mesh repair for para-umbilical hernia in Mardan Medical Complex, Mardan. Pak J Surg. 2021 Apr 1;37(2):70-5.