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. 2025 May 27;17(5):e84893.
doi: 10.7759/cureus.84893. eCollection 2025 May.

A Prospective Observational Study Comparing Retrorectus and Anterectus Mesh Placement in Incisional Hernia Repair

Havil Stephen Alexander Bakka  1 , Prathibha Kamepalli  2 , Kayaththery Varathan  3 , Adele Zacken  4 , Tharaga Kirupakaran  5 , Daniel I Koshy  6 , Sanjeevi Bharadwaj  7 , Suryanarayana Bandlamudi  2
Affiliations

A Prospective Observational Study Comparing Retrorectus and Anterectus Mesh Placement in Incisional Hernia Repair

Havil Stephen Alexander Bakka et al. Cureus. .

Abstract

Background Incisional hernias are a frequent complication following abdominal surgeries, significantly contributing to morbidity. Surgical repair using mesh placement has become the standard of care, with ongoing debates regarding the optimal anatomical plane for mesh placement. Even though the retrorectus plane advocated by Rives and Stoppa has become the choice of plane for most surgeons, it is not without recurrence. This prospective observational study compares the outcomes of incisional hernia repair using anterectus versus retrorectus mesh placement techniques. Patients and methods A total of 60 patients were enrolled from April 1, 2022, to April 1, 2024, at NRI Medical College & General Hospital, Vijayawada, India, divided equally into two groups. Group A included patients who underwent retrorectus hernioplasty, while Group B had anterectus hernioplasty. Parameters evaluated include epidemiological data, defect size, content, mesh size, operative time, postoperative pain, drain output, postoperative complications, hospital stay, recovery time, and recurrence rates. Results Results demonstrated a statistically significant advantage of the retrorectus approach with reduced operative time (160 ± 16 min vs. 216 ± 28 min; p < 0.0001), lower postoperative pain scores, decreased drain output, shorter hospital stays (5.6 ± 0.6 days vs. 15.7 ± 6.6 days; p < 0.0001), and fewer wound complications after a mean follow-up period of (17.4 +/- 4.7) months in group A and (18.3+/- 4.7) months in group B. Neither group had recurrences during the follow-up period. Conclusions This study concludes that retrorectus hernioplasty is superior to anterectus hernioplasty with less postoperative morbidity, shorter hospital stays, and accelerated patient recovery.

Keywords: abdominal wall surgery; anterectus repair; hernia recurrence; hernioplasty; incisional hernia; mesh placement; postoperative complications; retrorectus mesh repair; surgical outcomes; surgical outcomes research.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Ethics Committee of NRI Medical College and General Hospital, Chinakakani, Guntur District, A.P issued approval IEC PG60/Gen Surg4/2021-22, granted on June 13, 2022. The Institutional Ethics Committee of NRI Medical College is re-registered with the Directorate General of Health Services, Central Drugs Standard Control Organization, Government of India, vide registration no. ECR/1160/Inst/AP/2018/RR-22. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Hernia defect
Figure 2
Figure 2. Retrorectus plane creation between the rectus muscle and posterior rectus sheath
Figure 3
Figure 3. Mesh placement in the retrorectus plane
Figure 4
Figure 4. Anterectus plane creation between the rectus muscle and anterior rectus sheath
Figure 5
Figure 5. Closure of the posterior rectus sheath
Figure 6
Figure 6. Approximation of the rectus muscle
Figure 7
Figure 7. Mesh fixation
See this image and copyright information in PMC

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