Subcutaneous Onlay Laparoscopic Approach versus Laparoscopic Intraperitoneal Onlay Mesh Repair for Paraumbilical Hernias: A Randomised Clinical Trial

Introduction: Paraumbilical hernias are currently treated most effectively with a minimally invasive strategy. After the introduction of Intraperitoneal Onlay Mesh Placement (IPOM), it has been performed as a traditional technique for paraumbilical hernias, though there are many techniques such as placement of mesh in the preperitoneal/retromuscular space or subcutaneous space. However, there has been a constant debate over the choice of a better approach.

Aim: To compare the short-term outcomes of IPOM and Subcutaneous Onlay Laparoscopic Approach (SCOLA) repair (subcutaneous onlay mesh placement) for paraumbilical hernias.

Materials and Methods: A randomised clinical trial was conducted in the Department of General Surgery, SRM medical college hospital and research centre, Chennai, Tamil Nadu, India, from March 2021 to August 2022. Study was conducted on patients undergoing laparoscopic hernia mesh repair for paraumbilical hernia. A total of 60 individuals were included in the study. They were placed in groups A and B according to block randomisation with concealed cover. Group A got laparoscopic SCOLA repair and group B got laparoscopic IPOM repair. The patients were tracked for a total of six months. A comparison of two groups was done to evaluate which technique is superior over the other in terms of duration of hospitalization, cost-effectiveness, duration of surgery, postoperative pain, postoperative complications, speed of recovery and returning to routine activity and recurrence.

Results: Total 60 participants were divided into two groups, 30 subjects each in group A and group B with a mean±Standard Deviation (SD) age of the subjects in SCOLA group and IPOM group was 37.50±8.41 years and 37.87±9.18 years, respectively. Laparoscopic SCOLA repair for paraumbilical hernia has a comparable outcome to the traditional laparoscopic approach like IPOM in terms of postoperative wound healing (p-value=0.25). A 6-month follow-up revealed no recurrence in either group. Being a newer procedure that requires extensive dissection, the operating time (p-value=0.001), seroma formation (p-value=0.057) and number of hospital days (p-value=0.001) was higher for SCOLA. Also, it was noted that patients who underwent IPOM had significantly more pain experienced as compared to those undergoing SCOLA (p-value 0.45, 0.01 and 0.66 on postoperative days 1, 3 and 5, respectively). Moreover, a significant advantage of SCOLA is its cost-effectiveness.

Conclusion: With the advantages of cost-effectiveness and lesser pain, SCOLA approach may be used more frequently in selected patients.