COMPARATIVE STUDY OF SURGICAL OUTCOME OF ANATOMICAL VERSUS MESH REPAIR OF VENTRAL ABDOMINAL HERNIA

Abstract

Background: Ventral abdominal hernia repair remains a frequent surgical challenge, with ongoing debate over the optimal repair technique. While mesh repair has been associated with reduced recurrence rates, its utilization in low-resource settings such as Pakistan warrants contextual assessment. This study compared surgical outcomes, postoperative complications, and patient comfort following anatomical versus mesh repair of ventral abdominal hernias. Objective: To evaluate and compare operative efficiency, postoperative pain, and short-term complications between anatomical and mesh repair techniques for ventral abdominal hernias. Study Design: Randomized controlled trial. Settings:  Department of Surgery, Aziz Bhatti Shaheed Teaching Hospital, Gujrat, Pakistan. Duration of Study:  March 29, 2025, to June 29, 2025. Methods:  A total of 160 patients aged 20–70 years presenting with ventral hernia defects ≤2 cm were randomly allocated into two equal groups: Group A (anatomical repair) and Group B (mesh repair). Demographic characteristics, operative time, postoperative pain (assessed using the Visual Analogue Scale at 24 hours), and early postoperative complications (seroma, hematoma, wound infection within 15 days) were recorded. Data were analyzed using SPSS version 25, and p-values <0.05 were considered statistically significant. Results: The mean patient age was 43.6 ± 11.7 years, with 60% males and a mean BMI of 27.3 ± 2.8 kg/m². The mean operative time was significantly shorter in the mesh repair group (55.2 ± 6.8 minutes) compared to the anatomical repair group (63.4 ± 7.1 minutes; p < 0.001). Mild-to-moderate postoperative pain was observed in 30% of mesh repair patients versus 65% in anatomical repair patients (p < 0.001). The overall complication rate was slightly lower in the mesh group (16.3%) than in the anatomical group (21.3%; p = 0.37), although seroma formation was more common following mesh repair (10% vs 3.8%; p = 0.10). Composite favorable outcomes—defined as operative time ≤ 60 minutes, mild-to-moderate pain, and absence of complications—were significantly higher in the mesh repair group (80%) compared to the anatomical repair group (55%; p = 0.002). Conclusion: Mesh repair of ventral abdominal hernias ≤2 cm offers superior operative efficiency and improved postoperative comfort with comparable complication rates to anatomical repair. Despite a slightly increased incidence of seroma, mesh repair represents a more effective and patient-satisfactory approach in tertiary care settings of Pakistan.