To compare the efficacy and complications of different patch placement (sublay and intraperitoneal onlay mesh) in the treatment of incisional hernia.

A retrospective analysis on the clinical data of 72 patients with incisional hernia admitted to the Yixing People's Hospital from January 2015 to January 2018 was performed, including 35 cases of intraperitoneal onlay mesh (IPOM group) and 37 cases of retrorectus mesh placement (sublay group). The basic conditions of surgery (operation time, postoperative hospital stay, total hospitalization cost, intraoperative blood loss), complications (intestinal injury, intestinal obstruction, intestinal fistula, wound infection, incision fat liquefaction), Visual analogue scale (VAS) on the 1st and 3rd postoperative day and 1-year follow-up recurrence were observed.

The operation time and postoperative hospital stay in the IPOM group were shorter than those in the sublay group, while the intraoperative blood loss in the IPOM group was lower than that in the sublay group; however, the total cost of hospitalization in the IPOM group was higher than that in the sublay group (P<0.05). The incidence of intestinal injury, intestinal obstruction, wound infection and incision fat liquefaction in the IPOM group were lower than those in the sublay group. In the IPOM group, 1 case (2.86%) had intestinal fistula, and there was no intestinal fistula in the sublay group without significant difference (P>0.05). There was no significant difference in pain score between the two groups on the 1st day and the 3rd postoperative day (P>0.05). There was no recurrence in the IPOM group after 1 year of follow-up, and 2 cases (5.71%) recurrence in the sublay group after 7 months (P>0.05).

Both two patch placement methods are effective in treating incisional hernia, but intra-abdominal repair is better with less complications.