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Abstract

Background: Incisional hernia represents a significant complication following abdominal surgery with an incidence of approximately 20%. This study compares the outcomes of retromuscular prefascial mesh placement versus onlay mesh repair in incisional hernia surgery.
Methods: A prospective comparative study was conducted at Mahatma Gandhi Memorial Hospital, Warangal, from August 2022 to July 2024. Fifty patients with incisional hernia were randomly allocated into two equal groups: Group A underwent retromuscular prefascial mesh placement (Rives-Stoppa technique) and Group B underwent onlay mesh repair. Inclusion criteria included age 15-65 years, defect size <20 cm, and fitness for anesthesia. Primary outcomes included recurrence rates and postoperative complications. Secondary outcomes included operative parameters and patient satisfaction.
Results: The study population comprised 32 females and 18 males with mean age 44.6±10.5 years. Obstetric surgeries accounted for 62% of previous operations. The prefascial group showed significantly higher perioperative hemorrhage rates (28% vs 4%, p=0.04) but significantly lower postoperative infection rates: superficial wound infection (4% vs 32%, p=0.02) and deep wound infection (4% vs 28%, p=0.04). Overall early postoperative complications were lower in the prefascial group (24% vs 60%, p=0.01). No recurrence occurred in the prefascial group compared to 4% in the onlay group during follow-up.
Conclusion: While both techniques are effective, retromuscular prefascial mesh placement offers superior infection control despite higher perioperative bleeding risk. The technique demonstrates excellent outcomes with zero recurrence rates, making it a preferred approach for experienced surgeons managing appropriately selected patients with incisional hernias.