Onlay Technique in Ventral Hernia: Are Superior Results Possible? Results from a Single Surgeon's Experience

Shenoy R, Blair K, Chandler CF. Onlay Technique in Ventral Hernia: Are Superior Results Possible? Results from a Single Surgeon's Experience. [Abstract]. Journal of the American College of Surgeons. 2020 Oct 1; 231(4S2):e133.

INTRODUCTION: Ventral hernias significantly impair patient's quality of life and are commonly repaired. Optimal technique for repair remains controversial. While the onlay method is a technically easier approach, recent studies have argued that sublay technique has the lowest surgical site (SSI) rate and recurrence rate. We hypothesize that one can achieve similar, favorable rates of SSI and recurrence while using an onlay technique. METHODS: A single surgeon's six year experience (10/2013-8/ 2019) was reviewed for all ventral hernia repairs utilizing onlay hernia technique. The primary outcomes were SSI and recurrence. RESULTS: 259 patients with onlay mesh hernia repairs were identified. Only 6.95% (N¼18) of patients experienced SSI and 5.79% (N¼15) of patients experienced recurrence. On multivariate logistic modeling, after adjusting for several demographic and clinical factors, sex was the only significant predictor for SSI, with women having a 6.92 higher odds of experiencing SSI than men (AOR 6.92, p¼0.012). Diabetes, smoking, and occurrence of component separation were not significantly associated with SSI or recurrence on univariate or multivariate analysis in our cohort for this surgical technique. CONCLUSION: While recent studies suggest that the sublay technique has the lowest rates of SSI and recurrence, our data demonstrate that an onlay method may be favorable. In this sample, diabetes, smoking, preoperative immunosuppression, component separation and even body mass index did not appear to influence SSI or recurrence rate in adjusted analyses. Thus, we propose that this method of onlay technique is the superior choice for ventral hernia repair.