From Scar to Strength - Unravelling Open Surgical Techniques of Incisional Hernias: A Two Years Prospective Observational Study

Background: Incisional hernia is one of the most common complications following abdominal surgery, occurring in approximately 10–20% of laparotomies. Various open surgical techniques such as onlay, sublay, inlay, and component separation are used for repair. However, the optimal technique remains controversial due to variations in recurrence, wound complications, and postoperative morbidity. Aim: To evaluate the outcomes of different open surgical techniques used in the management of incisional hernia over a period of two years (March 2024-March 2026). Materials and Methods: This prospective observational study was conducted over a period of two years in the Department of General Surgery of a tertiary care hospital. A total of 60 patients diagnosed with incisional hernia were included. Patients underwent open surgical repair using different techniques such as onlay mesh repair, sublay mesh repair, inlay mesh repair, and anatomical repair depending on defect size and patient factors. Postoperative outcomes including surgical site infection, seroma formation, hospital stay, and recurrence were analysed. Results: Among the 60 patients, the majority were females (63.3%). The most common previous surgery leading to incisional hernia was lower segment cesarean section (36.7%). Onlay repair was performed in 10% of cases, sublay repair in 60%, inlay repair in 5%, and anatomical repair in 25%. Postoperative complications included seroma (13.3%), wound infection (10%), and recurrence (6.7%). Sublay repair demonstrated the lowest recurrence and complication rates. Conclusion: Open mesh repair remains the standard treatment for incisional hernia. Among different techniques, sublay mesh repair appears to provide better outcomes with lower recurrence and fewer wound complications compared to onlay and inlay techniques.