Meta-analysis of sublay versus onlay mesh repair in incisional hernia surgery

Lucas Timmermans, Barry de Goede, SM (Sven) van Dijk, Gert-jan Kleinrensink, J (Hans) Jeekel, Johan Lange

Research output: Contribution to journalArticleAcademicpeer-review

117 Citations (Scopus)


BACKGROUND: Incisional hernia (IH) remains a very frequent postoperative complication. The 2 techniques most frequently used are the onlay repair and sublay repair. However, it remains unclear which technique is superior. DATA SOURCES: A meta-analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The quality of the nonrandomized studies was assessed using the Newcastle-Ottawa Scale. RESULTS: Of 178 articles, 10 articles (2 randomized controlled trials, 1 prospective study, and 7 retrospective studies) comprising a total of 1,948 patients (775 onlay operations and 1173 sublay operations) were selected. Two of the studies scored below 5 points on the Newcastle-Ottawa Scale and were not selected. A trend was observed for IH recurrence in favor of sublay repair (odds ratio = 2.41; 95% confidence interval, .99 to 5.88; I-2 = 70%; P = .05). Surgical site infection occurred significantly less after sublay repair (odds ratio = 2.42; 95% confidence interval, 1.02 to 5.74; I-2 = 16%; P = .05). No difference was observed regarding seroma and hematoma. CONCLUSIONS: Although the majority of the included studies were retrospective studies, sublay repair seems the preferred technique for IH repair. (C) 2014 Elsevier Inc. All rights reserved.
Original languageUndefined/Unknown
Pages (from-to)980-988
Number of pages9
JournalAmerican Journal of Surgery
Issue number6
Publication statusPublished - 2014

Research programs

  • EMC ONWAR-01-94-01
  • EMC OR-02-47-12

Cite this