Background: Ventral hernias constitute one of the most frequently encountered abdominal wall hernias requiring operative intervention. Mesh repair has become the standard of care because of its lower recurrence rates compared with primary suture repair. Nevertheless, postoperative complications such as seroma formation, surgical site infection, skin necrosis, haematoma and chronic pain continue to contribute significantly to patient morbidity. Multiple patient-related factors, including obesity, diabetes mellitus, smoking, previous abdominal surgeries and the choice of mesh position, may influence postoperative outcomes. Identifying these factors is essential for optimizing surgical planning and reducing complications.

Objectives: To evaluate the incidence of early and late postoperative complications following mesh repair of ventral hernias and to determine the association of these complications with patient-related risk factors, type of ventral hernia and mesh position.

Materials and Methods: A hospital-based cross-sectional observational study was conducted in the Department of General Surgery, K.H. Patil Institute of Medical Sciences, Gadag, over a period of two years from March 2024 to February 2026. One hundred consecutive patients undergoing elective or emergency mesh repair for ventral hernias were enrolled using universal sampling. Demographic characteristics, clinical presentation, associated risk factors, type of ventral hernia, mesh position, anaesthesia and postoperative outcomes were recorded prospectively. Statistical analysis was performed using SPSS software. Associations between variables were analysed using Chi-square test, Fisher's exact test and independent t-test. A p-value <0.05 was considered statistically significant.

Results: The mean age of the study population was 46.07 ± 13.21 years, with females accounting for 63% of patients. Umbilical hernia was the commonest ventral hernia (71%), followed by incisional, paraumbilical and epigastric hernias. Obesity was the most prevalent associated risk factor (46%). Onlay mesh placement was performed in 53% of patients, while sublay and preperitoneal repairs accounted for 25% and 22%, respectively. Early postoperative complications occurred in 31% of patients, with seroma (14%) and skin necrosis (13%) being the most common complications. No late postoperative complications were observed during follow-up. Mesh position demonstrated a statistically significant association with postoperative complications (p = 0.0009), whereas age, gender, hernia type and associated risk factors did not show significant associations

Conclusion: Mesh position significantly influences postoperative outcomes following ventral hernia repair. Sublay and preperitoneal mesh placement were associated with lower postoperative complication rates compared with onlay repair. Whenever technically feasible, deeper mesh placement should be preferred to minimize postoperative morbidity and improve surgical outcomes.