Ventral Hernia Repair With Onlay Placement of Biosynthetic Ovine Rumen Is Noninferior to Retrorectus Placement.

Abstract

<h4>Background</h4>Mesh placement impacts postoperative outcomes in ventral hernia repair (VHR). The retrorectus technique is associated with lower recurrence rates than the onlay technique. Hybrid meshes, combining synthetic and biologic benefits, have been introduced, but the effect of placement location on outcomes remains unclear.<h4>Methods</h4>We retrospectively analyzed 71 patients who underwent VHR with biosynthetic ovine rumen in either an onlay (n = 38) or retrorectus (n = 33) position. We compared demographics, comorbidities, complications, and recurrent rates. Multivariate logistic regression assessed associations between mesh placement and outcomes.<h4>Results</h4>Onlay patients were older (mean 62.9 versus 57.4 y, <i>P</i> = 0.03) and had larger hernias (158 versus 73.8 cm², <i>P</i> < 0.001). Most patients had grade 2 or 1 hernias according to the modified ventral hernia working group classification, with no significant differences in postoperative complications. Hernia recurrence occurred in 5.41% of onlay patients and 0% of retrorectus patients.<h4>Conclusions</h4>No significant differences in complications or recurrence rates were observed between placement techniques. These findings suggest that hybrid mesh placement in an onlay position is a safe and durable strategy for VHR.