الفهرس 
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Abstract
Hernias of the anterior abdominal wall, or ventral hernias have a various types that can be categorized into either congenital or acquired, also can be categorized according to various locations into primary ventral hernias (true ventral- non incisional hernias) which include two subtypes lateral ventral hernia, and midline ventral hernias. The cause of a primary ventral hernia is far from completely understood, but it is undoubtedly multifactorial. Familial predisposition plays a role. There is increasing evidence that connective tissue disorders. Incisional hernias (acquired hernias) is another type according to the location, occur at the site of a pervious surgical scar. They are considered as a leading cause of abdominal surgery account for 15-20% of all abdominal wall hernias. The evaluation of ventral hernia requires diligent physical examination combined with imaging modalities that play a greater role in diagnosis of more unusual or complicated hernias. Complications of ventral hernia include effects of strangulation and post-operative complications, but recurrence still the ultimate nightmare of hernia surgeon. Recurrence reduced after use of permanent prosthetic mesh for repair. Management of ventral hernia starts from a through medical history taking and assessment, treatment include non-invasive (medical reduction or truss placement) and invasive (surgical), although surgery has been the most effective maneuver achieving it. Classically repair was done proposed by Mayo, but with increased tension on the repair and recurrence rates almost 30%, instead defects are closed primarily and reinforced via prosthetic mesh, fascial auto grafts or metallic mesh. The introduction of prosthetics has revolutionized hernia surgery with the concept of tension free repair remains the most efficient method of dealing with ventral hernia. The prosthetic mesh can be placed between the subcutaneous tissues of the abdominal wall and the anterior rectus sheath (onlay mesh repair),in the preperitoneal plane created between the rectus muscle and posterior rectus sheath ( retromuscular or sublay mesh repair) as well as Sandwich style (both onlay and sublay, finger interdigitation….ect. The sublay technique has several advantages, one of being not transmitting the infection from subcutaneous tissues down to the mesh as it lies quite deep in the preperitoneal plane. Moreover the mesh implanted in the preperitoneal space unites and consolidates the anterior abdominal wall. The mesh also adheres to the posterior rectus sheath and renders it inextensible allowing no further herniation. Recent approaches for ventral hernia repair as laparoscopic and components separation techniques. In this thesis, a comparative study between two methods of surgical treatment for ventral hernia was made. The study included 40 adult patients with uncomplicated ventral hernia divided randomly into two groups according to the surgical technique used for the repair, without any specific criteria used in selection for any technique as follows: • Group A (Onlay mesh repair): Twenty patients were operated by placing the mesh above the anterior rectus sheath and the external oblique muscle. Group B (Sublay”Reteromuscular”mesh repair): Twenty patients were operated by placing the mesh in the retro- muscular space. In this study no significant difference found between both methods as regarding: • Age and gender. • Type of ventral hernia. • Duration of the operative procedure. • Amount of intra-operative blood loss. • Postoperative hospital stay. • Hernia recurrence. Significant difference found to be between both groups as regarding; • Time to remove the drains (longer in onlay mesh group). • Seroma formation after drain removal (Significantly higher in onlay mesh group). • Wound infection (Significantly higher in onlay mesh group).