ABSTRACT

Background: Incisional hernia is a common complication following abdominal surgery, and mesh reinforcement has become

the standard of care. This study aimed to compare the clinical outcomes of sublay versus onlay mesh repair in patients with

incisional her

nia.

Methods: This prospective randomized controlled clinical trial was conducted at the General Surgery Department, Faculty

of Medicine, ..... Hospitals. A total of 60 patients diagnosed with incisional hernia and scheduled for elective surgical repai

r

were recr

uited from general surgery outpatient clinics and the emergency department. Patients were randomly assigned into

two equal groups: Group A (Onlay Group, n=30) underwent onlay mesh repair, and Group B (Sublay Group, n=30)

underwent sublay (retrorectus) mesh

repair. Baseline demographic, clinical, laboratory, and radiological characteristics were

recorded. Operative parameters, postoperative pain scores (Visual Analogue Scale), hospital stay, return to normal activity,

postoperative complications (seroma, hem

atoma, surgical site infection), and hernia recurrence at 12 months were compared

between the two groups.

Results: Operative time was significantly shorter in the onlay group (88.93 ± 7.93 minutes) compared to the sublay group

(99.67 ± 7.74 minutes) (p < 0.001). Postoperative pain scores were significantly lower in the sublay group at day 1 (4.70 ±

0.76 vs. 6.

10 ± 0.79), 1 week (2.39 ± 0.75 vs. 3.99 ± 0.82), 1 month (0.85 ± 0.74 vs. 2.41 ± 0.88), 3 months (0.30 ± 0.49 vs.

1.41 ± 0.86), 6 months (0.16 ± 0.36 vs. 1.02 ± 0.82), and 12 months (0.14 ± 0.48 vs. 0.82 ± 0.86) (p < 0.001 for all). Hospit

al

stay was sign

ificantly shorter in the sublay group (3.47 ± 1.11 days vs. 4.40 ± 0.93 days, p < 0.001), and return to normal

activity was significantly earlier (21.53 ± 3.41 days vs. 26.07 ± 4.73 days, p < 0.001). No significant difference was found

in drain removal day

(p = 0.257). Postoperative complications including seroma (10.0% vs. 23.3%, p = 0.299), hematoma

(3.3% vs. 6.7%, p = 1.000), and surgical site infection (6.7% vs. 16.7%, p = 0.424) were directionally lower in the sublay

group but did not reach statistical

significance. Hernia recurrence at 12 months was 3.3% in the sublay group versus 10.0%

in the onlay group (p = 0.612). All patients completed the 12

-

month follow

-

up.

Conclusion: Sublay (retrorectus) mesh repair offers significant clinical advantages over onlay mesh repair for incisional

hernia, including superior postoperative pain control, shorter hospital stay, and earlier return to normal activity. Postoper

ative

com

plications and recurrence showed consistent trends favoring sublay repair. These findings support sublay mesh repair as

the preferred technique for elective incisional hernia repair in appropriately selected patients.

.

Keywords

: Incisional hernia, mesh repair, sublay, retrorectus, onlay, postoperative pain, randomized controlled trial.