INTRODUCTION: Abdominal wall hernia is one of the most important subjects for all surgeons operating on abdomen. Ventral hernia is an umbrella term that includes several types of hernias occurring along the anterior abdominal wall. About 5% of the population develop a ventral hernia at some time in their life.Several techniques for the repair of ventral hernia have been described from time to time. Mesh repair has become the gold standard in the elective management of most ventral hernias. It can be categorized according to the way in which the mesh is placed as well as its relationship to the abdominal wall fascia. Each mesh location has its own risks and benefits. The ideal technique should result in low recurrence, reconstruction of a functional abdominal wall and low rate of complications.

AIMS AND OBJECTIVES: The aim of the present study is to evaluate and compare the efficacy of onlay and retrorectus mesh placement for repair of ventral abdominal hernia taking in consideration the intraoperative aspects and postoperative complications. This study is an effort to suggest the best open approach for repair of ventral hernia.

MATERIALS AND METHODS: This is a prospective study in which a total of 50 patients were enrolled. Patients were divided into two groups, Group A included 25 patients managed by traditional onlay mesh repair and group B included 25 patients managed by retrorectus mesh repair. Only the patients with uncomplicated midline hernia not more than 10cm were included in the study.

RESULTS: The operative time for retro–rectus repair was significantly higher than that of onlay mesh repair but the postoperative hospital stay was shorter in retro–rectus groupThere was no significant difference between both the groups in terms of seroma formation, Surgical site infection (SSI), mesh infection or recurrence. However, onlay repair was associated with complications like seroma formation and wound infection while incidence of complications in retrorectus repair group was nil.

CONCLUSION: This study has a shorter follow–up period of 6 months, hence late recurrences could not be recorded. Although the operative time in the retro–rectus group was higher but the reduced postoperative stay and negligible incidence of postoperative complications emphasizes on the fact that retro‑rectus mesh placement is a simple and effective technique that could be adopted widely by surgeons.