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Systematic Review ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Surg. | doi: 10.3389/fsurg.2018.00071

Onlay technique in incisional hernia repair – A systematic review

  • 1Department of Surgery and Centre for Minimally Invasive Surgery, Vivantes Klinikum, Germany

A meta-analysis that compared the onlay versus sublay technique in open incisional hernia repair identified better outcomes for the sublay operation. Nonetheless, an Expert Consensus Guided by Systematic Review found the onlay mesh location useful in certain settings. Therefore, all studies on the onlay technique were once again collated and analyzed.

Material and Methods
A systematic search of the available literature was performed in August 2018 using Medline, PubMed, Scopus, Embase, Springer Link, and the Cochrane Library. For the present analysis 41 publications were identified as relevant.

In five prospective randomized trials and 17 observational studies the postoperative complication rates ranged between 5% and 76%, with a mean value of 33.5%. The recurrence rates in these studies also ranged between 0% and 32%, with a mean value of 9.9%. Hence, compared with the literature data on the sublay operation, more postoperative complications, in particular wound complications and seroma, with a comparable recurrence rate, were identified.

When the onlay technique is used in certain settings for incisional hernia repair, an careful dissection technique and prophylactic measures (drainage, abdominal binders, fibrin sealant) should be employed to prevent wound complications and seroma formation.

Keywords: incisional hernia, Onlay technique, Wound complications, Surgical site infection, Seroma, Recurrence

Received: 05 Sep 2018; Accepted: 08 Nov 2018.

Edited by:

Evangelos P. Misiakos, National and Kapodistrian University of Athens, Greece

Reviewed by:

Bassem S. Hegab, National Liver Institute, Egypt
Jan F. KUKLETA, Independent researcher  

Copyright: © 2018 Köckerling. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Ferdinand Köckerling, Vivantes Klinikum, Department of Surgery and Centre for Minimally Invasive Surgery, Berlin, 13585, Germany,