title: Open retromuscular mesh repair versus onlay technique of incisional hernia: A randomized controlled trial.
abstract: BACKGROUND
  The aim of this prospective randomized clinical study was to compare and analyze the results of two methods of treatment of incisional hernia: open retromuscular mesh repair and onlay technique.
  
  
  METHODS
  180 patients who underwent open elective surgery for middle primary incisional hernia were randomized into two groups. The retomuscular mesh repair was used in the first group and the onlay technique - in the second group. Several preoperative and intraoperative factors, also wound complications (wound infection, hematoma, seroma) and hernia recurrence rate were determined and compared between the groups.
  
  
  RESULTS
  The operative time was significantly longer in the retromuscular group compared with the onlay group (P < 0.001). In the retromuscular group 17 (22.1%) wound complications were observed, in the onlay group-39 (50.0%) wound complications. The difference was statistically significance (P < 0.001). Seroma was the most frequent postoperative wound complication, ranging from 16.9% to 41.0% among the groups, respectively (P = 0.0013). No significantly difference has been found between groups by wound infection and hematoma. 2 (2.6%) case of hernia recurrence was marked in retromuscular group and 4 (5.1%) case of hernia recurrence - in onlay group. But there was no statistically significantly difference between the two groups.
  
  
  CONCLUSIONS
  Our research shows no significant difference in frequency of hernia recurrence between retromuscular mesh repair and onlay technique for treatment of incisional hernia. The usage of the retromuscular mesh repair is associated with significantly less wound complications than onlay technique. That can be considered as an advantage of retromuscular method, which makes it more preferential than onlay method.
authors.affiliation: Department of Surgery, Tbilisi State Medical University, 33, Vazha-Pshavela ave, 0177, Tbilisi, Georgia; Department of Surgery, Kipshidze Central University Hospital, 29, Vazha-Pshavela ave, 0160, Tbilisi, Georgia. Electronic address: zdemetr@yahoo.com.
authors.forename: Zaza
authors.initials: Z
authors.lastname: Demetrashvili
authors.affiliation: Department of Surgery, Kipshidze Central University Hospital, 29, Vazha-Pshavela ave, 0160, Tbilisi, Georgia; Institute Medical Research, Ilia State University, Tbilisi, Georgia. Electronic address: iraklipipia@yahoo.com.
authors.forename: Irakli
authors.initials: I
authors.lastname: Pipia
authors.affiliation: Department of Surgery, Kipshidze Central University Hospital, 29, Vazha-Pshavela ave, 0160, Tbilisi, Georgia. Electronic address: davit2311@gmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Loladze
authors.affiliation: Department of Surgery, Tbilisi State Medical University, 33, Vazha-Pshavela ave, 0177, Tbilisi, Georgia. Electronic address: t7metreveli@gmail.com.
authors.forename: Tamar
authors.initials: T
authors.lastname: Metreveli
authors.affiliation: Department of Biochemistry, Tbilisi State Medical University, 33, Vazha-Pshavela ave, 0177, Tbilisi, Georgia. Electronic address: ekaekaladze@yahoo.com.
authors.forename: Eka
authors.initials: E
authors.lastname: Ekaladze
authors.affiliation: Department of Surgery, Kipshidze Central University Hospital, 29, Vazha-Pshavela ave, 0160, Tbilisi, Georgia. Electronic address: gugaken@yahoo.com.
authors.forename: George
authors.initials: G
authors.lastname: Kenchadze
authors.affiliation: Department of Surgery, Kipshidze Central University Hospital, 29, Vazha-Pshavela ave, 0160, Tbilisi, Georgia. Electronic address: kadoc72@Yahoo.com.
authors.forename: Kakhi
authors.initials: K
authors.lastname: Khutsishvili
mesh_terms: D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D000069290:Incisional Hernia / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications; D011446:Prospective Studies; D012008:Recurrence; D049291:Seroma / Q000209:etiology; D013526:Surgical Mesh
keywords: Incisional hernia; Onlay technique; Recurrence; Retromuscular mesh repair; Wound complications