title: Meta-analysis of sublay versus onlay mesh repair in incisional hernia surgery.
abstract: 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.
  
  
  METHODS
  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.
authors: Department of Surgery, Erasmus MC, University Medical Center, Z-835, 3000 CA Rotterdam, The Netherlands. Electronic address: lucastimmermans@gmail.com.
authors: Lucas
authors: L
authors: Timmermans
authors: Department of Surgery, Erasmus MC, University Medical Center, Z-835, 3000 CA Rotterdam, The Netherlands.
authors: Barry
authors: B
authors: de Goede
authors: Department of Surgery, Erasmus MC, University Medical Center, Z-835, 3000 CA Rotterdam, The Netherlands.
authors: Sven M
authors: SM
authors: van Dijk
authors: Department of Neuroscience, Erasmus MC, University Medical Center, Z-835, 3000 CA Rotterdam, The Netherlands.
authors: Gert-Jan
authors: GJ
authors: Kleinrensink
authors: Department of Neuroscience, Erasmus MC, University Medical Center, Z-835, 3000 CA Rotterdam, The Netherlands.
authors: Johannes
authors: J
authors: Jeekel
authors: Department of Surgery, Erasmus MC, University Medical Center, Z-835, 3000 CA Rotterdam, The Netherlands.
authors: Johan F
authors: JF
authors: Lange
mesh_terms: D006555:Hernia, Ventral / Q000209:etiology / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D013526:Surgical Mesh; D013536:Suture Techniques
keywords: Complication; Incisional hernia; Onlay; Recurrence; Sublay; Surgical site infection