Abstract
Recent data from the American Hernia Society Quality Collaborative (AHSQC) has shown comparable outcomes of onlay ventral hernia to other sublay techniques. Onlay ventral hernia repair was originally described by Chevrel in the 1970s. The focus of his original repair was recreation of the linea alba, and the use of a premuscular prosthesis to buttress the primary closure. Key features of onlay ventral hernia repair include creation of subcutaneous flaps, selective use of myofascial advancement flaps, mesh fixation with fibrin glue, and adequate drainage of the subcutaneous space postoperatively. Just as Chevrel indicated, the most important feature is recreation of a tension-free midline. In his large series of patients, he transitioned to the added use of fibrin glue fixation of the mesh over the midline closure coupled with suture fixation. The evidence for fibrin glue as a fixation method for mesh has been established in inguinal hernia literature and more recently has translated to onlay ventral hernia repair. Advantages include complete and immediate fixation of mesh, thereby theoretically taking tension off the midline closure. Clinically there may be advantages regarding less acute and chronic postoperative pain.
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Stoikes, N.F., Shahan, C.P., Webb, D., Voeller, G. (2017). Onlay Ventral Hernia Repair. In: Hope, W., Cobb, W., Adrales, G. (eds) Textbook of Hernia. Springer, Cham. https://doi.org/10.1007/978-3-319-43045-4_29
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DOI: https://doi.org/10.1007/978-3-319-43045-4_29
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