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. 2025 Aug 26;29(1):258.
doi: 10.1007/s10029-025-03427-3.

Association of mesh weight with adverse outcomes: a cohort study including 123,880 inguinal hernia repairs

Brandon Cowan  1 , Priscilla H Chan  2 , Sahil S Patel  1 , Heather A Prentice  2 , Kenneth Sucher  2 , Elizabeth W Paxton  2 , Elliott R Brill  3 , Lavina Malhotra  4 , Francisca M Maertens  5 , Gregory M Heitmann  6 , Rouzbeh Mostaedi  7
Affiliations

Association of mesh weight with adverse outcomes: a cohort study including 123,880 inguinal hernia repairs

Brandon Cowan et al. Hernia. .

Abstract

Purpose: Surgeons lack conclusive evidence to guide mesh choice for inguinal hernia repair. We sought to evaluate risk for recurrence, reoperation, and chronic postoperative inguinal pain (CPIP) compared among different mesh weight classes.

Methods: We conducted a cohort study including 123,880 repairs in adult patients who underwent first elective mesh-based inguinal hernia repair within a US integrated healthcare system (1/2010-6/2023). Mesh weight was categorized into lightweight (LW, < 50 g), medium-weight (MW, 50-90 g), and heavyweight (HW, > 90 g). Recurrence and reoperation during follow-up were primary outcomes while 5-year CPIP was a secondary outcome. Multivariable Cox regression was used to evaluate risk of primary outcomes, while multivariable logistic regression was used to evaluate the secondary outcome; all models included covariate adjustment and stratified by surgery type.

Results: LW, MW, and HW mesh were used in 49.0% (n = 23,685), 3.8% (n = 1,811), and 47.2% (n = 22,815) of minimally invasive (MIS) procedures, respectively; and were used in 55.7% (n = 42,097), 25.4% (n = 19,183), and 18.9% (n = 14,289) of open procedures, respectively. Among MIS repairs, LW mesh was associated with a lower risk of recurrence, reoperation, and CPIP versus HW, and a lower risk of recurrence and reoperation versus MW. Among open repairs, no difference was seen between LW and MW for recurrence, reoperation, and CPIP, while HW had a lower risk for recurrence and reoperation, but a higher likelihood of CPIP compared to LW.

Conclusion: LW mesh was associated with a long-term advantage with fewer postoperative complications for MIS repair. HW mesh was associated with higher CPIP risk following an open repair.

Keywords: Hernia mesh; Hernia recurrence; Inguinal hernia; Mesh weight; Reoperation.

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Conflict of interest statement

Declarations. Meeting presentation: This study was presented, #4432, at the ACS 2024 Clinical Congress in San Francisco, CA. No external funding was received for any aspect of this work. Competing interests: Brandon Cowan has a financial interest with Johnson & Johnson, unrelated to this work. The authors report no further financial interests. The authors report no non-financial interests. Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research. This work was performed at Medical Device Surveillance & Assessment, Southern California Permanente Medical Group, San Diego, CA, USA. This study was approved by the Kaiser Permanente Institutional Review Board IRB #12843.

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