Meta-analysis of sublay versus onlay mesh repair in incisional hernia surgery.

BACKGROUND: Incisional hernia (IH) remains a very frequent postoperative complication. The 2 techniques most frequently used are the onlay repair and sublay repair. However, it remains unclear which technique is superior.

DATA SOURCES: A meta-analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The quality of the nonrandomized studies was assessed using the Newcastle-Ottawa Scale.

RESULTS: Of 178 articles, 10 articles (2 randomized controlled trials, 1 prospective study, and 7 retrospective studies) comprising a total of 1,948 patients (775 onlay operations and 1173 sublay operations) were selected. Two of the studies scored below 5 points on the Newcastle-Ottawa Scale and were not selected. A trend was observed for IH recurrence in favor of sublay repair (odds ratio = 2.41; 95% confidence interval, .99 to 5.88; I(2) = 70%; P = .05). Surgical site infection occurred significantly less after sublay repair (odds ratio = 2.42; 95% confidence interval, 1.02 to 5.74; I(2) = 16%; P = .05). No difference was observed regarding seroma and hematoma.

CONCLUSIONS: Although the majority of the included studies were retrospective studies, sublay repair seems the preferred technique for IH repair.