A Comparative Study of Open versus Laparoscopic Sublay Repair for Ventral Hernia.

Abstract

<h4>Background</h4>Ventral hernias, particularly umbilical hernias, are the second most common type of abdominal wall hernias after inguinal hernias. Surgical intervention using mesh placement has become standard due to its effectiveness in reducing recurrence. Among mesh techniques, the sublay approach is widely practiced through both open and laparoscopic methods.<h4>Objective</h4>To compare the clinical outcomes of laparoscopic versus open sublay mesh repair in patients with ventral hernias.<h4>Materials and methods</h4>This was a prospective comparative study conducted over 2.5 years at a tertiary care center, involving 50 patients with uncomplicated ventral hernias and defect sizes less than 5 cm. Participants were randomly assigned to undergo either open sublay repair using the Rives-Stoppa technique or laparoscopic sublay mesh placement. Key parameters analyzed included operative time, postoperative pain using the Visual Analog Scale (VAS), duration of hospital stay, complication rates, and hernia recurrence over six months.<h4>Results</h4>The average surgical time was significantly lower in the open group (58.79 ± 3.12 minutes) compared to the laparoscopic group (72.11 ± 4.73 minutes; p < 0.01). However, patients undergoing laparoscopic repair experienced significantly less postoperative pain (VAS on Day 1: 5.15 vs. 7.91; at discharge: 1.09 vs. 3.77; p < 0.01). Hospitalization was shorter in the laparoscopic group (2.91 days vs. 4.70 days; p < 0.01), and postoperative complications, including infection and seroma, were less frequent (4% vs. 8%). Recurrence occurred in two patients (8%) in the open group, with none reported in the laparoscopic group during the follow-up.<h4>Conclusion</h4>Both laparoscopic and open sublay techniques are effective for ventral hernia repair. However, the laparoscopic approach offers clear advantages in terms of lower postoperative pain, fewer complications, and shorter hospital stay, making it a preferable option when feasible.