Onlay repair for abdominal wall hernias: a valid alternative. Systematic review and comparison with international standards.

Abstract

Ventral hernias are a common surgical challenge for general surgeons and several techniques have been described to repair it. The mesh positioning for the repair is a factor frequently mentioned as a major contributor to the outcome of the operation. Although onlay mesh repair is considered the simplest approach for ventral hernia repair, recent studies have led to its stigmatization. Even so, it could still be a reasonable option.<h4>Objective</h4>to evaluate the complications and recurrences documented with this technique and compare them to international quality standards for ventral hernia repair outcomes.<h4>Method</h4>Systematic review of the literature using PubMed, Cochrane, and EMBASE, following PRISMA criteria. Search terms "onlay hernia repair", from January 2020 to October 2024. The results were evaluated and compared to standard international results. The following data were extracted: MINORS criteria, number of patients, age, body mass index, comorbidities, variables related to hernia characteristics, including prior surgical repair, defect diameter, classification, surgical complications, including general complications, surgical site infections, seromas, hematomas, death, recurrence, and the follow-up period.<h4>Results</h4>Ten papers were analyzed, including 910 patients. The average age among the patients was 55.6 years, and 39.4% of the sample population was male. Their mean BMI was 31.4, and 36% had been diagnosed with cardiovascular disease. The incisional hernias were 74.6%, with 285 patients with midline hernias. The hernia defect diameter was 6.4 cm. The surgical complications: infections 10.1%, seroma 11.8%, hematoma 2,8%, wound dehiscence 4.4%, mortality 0.78%, recurrence 5.4% with median follow-up of 12 months.<h4>Conclusions</h4>The results of this review compared to international standards for hernia repair, show that onlay mesh appears is a suitable option for ventral hernia surgery, with low recurrence, complications and mortality rates. However, there is missing information in patient's comorbidities, hernia characteristics, and complications, emphasize the importance of structured and systematic methodologies in future research.