Choice of Mesh for Hernia Repair Tied to Risk of Reoperation

NEW YORK (Reuters Health) – The type of surgical mesh used for laparoscopic repair of primary or incisional ventral hernias is associated with the rate of reoperations, a new study from Denmark suggests.

“The findings indicate that the type of mesh may matter for the outcome and that the choice of mesh should depend on hernia type,” Dr. Jason Joe Baker of Herlev Hospital and colleagues write in Annals of Surgery, noting that the recurrence rates of up to 30% seen in laparoscopic ventral hernia repair “are still too high.”

The team examined data from 5,410 patients in a nationwide registry on adults who had undergone laparoscopic ventral hernia repair with an intraperitoneally placed mesh, fixated with absorbable or permanent tacks, between 2007 and 2020.

Among the 2,802 with primary hernias, the DynaMesh-IPOM group had the lowest rate of reoperation for recurrence and was used as the reference group. In comparison, patients who had received Physiomesh or Proceed Surgical Mesh had significantly higher risks of reoperation for recurrence (hazard ratios, 3.45 and 2.53, respectively).

Greater age seemed to reduce the risk of reoperation for recurrence (HR, 0.99; 95% confidence interval, 0.98 to 1.00), while larger transverse diameter of the defect increased that risk (HR, 1.03; 95% CI, 1.00 to 1.06).

In the incisional hernia cohort of 2,608 patients, Ventralight ST Mesh had the lowest rate of reoperation for recurrence and was used as the reference group. In comparison, four types of mesh had significantly higher hazard ratios: Physiomesh (HR, 3.90), Ventralex Hernia Patch (HR, 2.99), Proceed Surgical Mesh (HR, 2.63), and Parietex Composite, including Optimized (HR, 2.55).

Greater transverse diameter of the defect was associated with a significantly increased reoperation risk (HR, 1.05), and defect closure with a reduced risk (HR, 0.61).

The report notes that Physiomesh was taken off the market in 2016.

Dr. Baker, of the Center for Perioperative Optimization, told Reuters Health by email, “This research indicates that some of these meshes should be investigated further and that there is a need for post-market surveillance (as the EU is soon requiring).”

He advised surgeons that “they should keep being critical about new and old products, and that they should keep endorsing research as much as possible. With recurrence rates of up to 30%, it is definitely needed.”

Dr. Daniel Davila, a gastrointestinal surgeon at Northwestern University’s Feinberg School of Medicine, in Chicago, told Reuters Health by email that even beyond hernia type and size, multiple factors go into the complexity of hernia repair, “including patient comorbidities, prior surgical factors, and even biological factors (e.g., smoking or nutrition).”

The study has some strengths, he continued, “particularly in using prospectively gathered data from a nationwide database, which improves the completeness of some of their figures. Unfortunately, variables they cannot control for even with statistical adjustment make reliable analysis of the findings difficult to pin.”

Dr. Davila explained, “Why a mesh was used in a particular situation was unknown and uncontrolled for, such that certain meshes may have been used in more difficult hernias, making recurrence more tied to complexity than the mesh placed.”

“Still, the study can be applauded for using available information to take a broad look at the implications of mesh choice in recurrence,” he concluded.

Dr. Davila was not involved with the Danish study.

SOURCE: Annals of Surgery, online September 13, 2021.

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