الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
Ventral abdominal wall incisional hernia is defined as a defect in the musculo-fascial layers of the abdominal wall in the region of postoperative scar (El Santawy et al., 2014).
There is a slight increase in the incidence of incisional hernia in the female gender. The higher percentage of incisional hernia in females might be due to laxity of abdominal wall muscles after multiple pregnancies and also increased incidence of obesity in females (Singh et al., 2019).
The most common risk factor for development of incisional hernia was the occurrence of wound infection after the previous surgery that was found in 46.67% of their cases. Also obesity, smoking, chronic cough, diabetes mellitus and anemia were important risk factors for incisional hernia development (Garg et al., 2017).
Giant ventral hernias and complex abdominal wall reconstructions, on the other hand, are challenging tasks even for the most experienced hernia surgeons with no consensus as to which technique is the best suited for these procedures. The Rives-Stoppa-Wantz technique is a proven technique for ventral hernia repairs, but because of the limitation related to the rectus sheath, it is not a viable option for giant hernias and wall defects (Stoppa, 2000).
Unfavorable outcomes with traditional sutures and mesh techniques have led to the development of numerous new techniques. The classic (open anterior) component separation technique (ACST) was first reported by Albanese and later popularized by Ramirez as an autologous tissue repair technique (Scheuerlein et al., 2018).
However, its association with high recurrence rates has resulted in new modifications. Posterior component separation (PCS) with the transversus abdominis muscle release (TAR) (Petro et al., 2015).
Component separation is a technique used to provide adequate coverage for midline abdominal wall defects such as a large ventral hernia. This surgical technique is based on subcutaneous lateral dissection, fasciotomy lateral to the rectus abdominis muscle, and dissection on the plane between external and internal oblique muscles with medial advancement of the block that includes the rectus muscle and its fascia. This release allows for medial advancement of the fascia and closure of up to 20-cm wide defects in the midline area. Although the current trend is to proceed with minimally invasive component separation and to reinforce the fascia with mesh, the basic principles of the techniques as described by Ramirez et al in 1990 have not changed over the years (Lowe et al., 2000).
In our study ten trials included comparison between onlay and sublay mesh in large insicional hernia repair were selected from electronic databases.
Ten included studies described recurrence using onlay versus sublay with follow-up at least 3 months, Demetrashvili et al., Ahmed and Mehboob, somooro et al.,Saeed et al., Barış Sevinç et al., Badawy et al. in addition to, Leithy et al., Alsoudany et al. Natarajan et al. and A. Iljin et al. with(P = 0.94, I2 = 0%) and OR 2.228, 95% CI 0.9, 5.378 and no statistically significance
Ten included studies described infection using onlay versus sublay with follow-up at least 3 months, Demetrashvili et al., Ahmed and Mehboob, somooro et al.,Saeed et al., Barış Sevinç et al., in addition to, Leithy et al., Alsoudany et al. Natarajan et al. and A. Iljin et al. with (P = 0.296, I2 = 16%) and OR 2.726, 95% CI 1.579, 4.705 and no statistically significance
Seroma was assessed in nine included studies comparing between onlay verus sublay.
Demetrashvili et al., Ahmed and Mehboob, somooroet al.,Saeed et al., Barış Sevinç et al., Badawy et al. in addition to, Natarajan et al. and A. Iljin et al. with (P = 0.917, I2 = 0%) and OR 4.962, 95% CI 3.038, 8.107 and no statistically significance
Hematoma was assessed in four included studies comparing between onlay verus sublay.
Demetrashvili et al., Saeed et al., Barış Sevinç et al., in addition to A. Iljin et al. with (P = 0.534, I2 = 0%) and OR 0.860, 95% CI 0.291, 2.541 and no statistically significance
Flap necrosis was assessed in four included studies comparing between onlay verus sublaywith follow-up at least 3 months,
Somooro et al., Badawy et al. in addition to,Leithy et al., and A. Iljin et al. with (P = 0.923, I2 = 0%) and OR 2.415, 95% CI 0.661, 8.822and no statistically significance
Eight included studies described operative time using onlay versus sublay, Demetrashvili et al., Ahmed and Mehboob, Soomro et al., Saeed et al., Barış Sevinç et al., Hamed et al. in addition to, Alsoudany et al. and A. Iljin et al. with (P = 0.001, I2 = 95.1%) and OR 12.022, 95% CI -31,460, 5.616 and there is statistically significance
Seven included studies described hospital stay using onlay versus sublay, Demetrashvili et al., Ahmed and Mehboob, Saeed et al., Barış Sevinç et al., Badawy et al. in addition to, Alsoudany et al. and A. Iljin et al. with (P = 0.001, I2 = 96.03%) and OR 2.726, 95% CI -1.250, 1.759 with statistically significance