Long-term Comparison of Recurrence Rates Between Different Lightweight and Heavyweight Meshes in Open Anterior Mesh Inguinal Hernia Repair: A Nationwide Population-based Register Study

Ann Surg. 2021 Feb 1;273(2):365-372. doi: 10.1097/SLA.0000000000003219.


Objective: To compare the reoperation rate for recurrence of different lightweight to heavyweight meshes after an open anterior mesh (OAM) inguinal hernia repair.

Summary background data: Lightweight meshes have shown benefits compared with heavyweight meshes in terms of accelerated recovery after surgery with less postoperative pain. The use of such meshes may, however, be associated with an increase in hernia recurrence. Studies of large cohorts with long-term follow-up regarding recurrence are lacking.

Methods: All OAM groin hernia repairs registered in The Swedish Hernia Register between January 1, 2005 and December 31, 2013 were eligible. Follow-up time was until June 30, 2016. Four groups of meshes were included: polypropylene (PP) heavyweight meshes >50 g/m2 (HWM), regular lightweight PP meshes <50 g/m2 (regular LWM-PP), lightweight PP mesh with absorbable poliglecaprone-25(LWM-PP/PGC), or polyglactin-910(LWM-PP/PG). Primary endpoint was reoperation for recurrence.

Results: 76,495 OAM inguinal hernia repairs in male patients were included for statistical analysis. 1676 repairs were reoperated for recurrence. Multivariate analysis demonstrated no significant difference of risk for recurrence between HWM and regular LWM-PP (HR 1.12, P = 0.13). LWM-PP/PGC (HR 1.42, P < 0.001) and LWM-PP/PG (HR 2.05, P < 0.001) resulted in a significant increased risk compared with HWM. Larger hernia defects, direct hernias, and recurrent hernias were associated with an increased risk of reoperation for recurrence.

Conclusions: Although lightweight meshes with partially absorbable component resulted in an increased risk of recurrence, there was no difference between regular LWM-PP and HWM. Considering that regular LWM-PP has less associated side effects there are no benefits of using HWM in OAM inguinal hernia repair.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Female
  • Hernia, Inguinal / surgery*
  • Herniorrhaphy / instrumentation*
  • Humans
  • Male
  • Middle Aged
  • Polypropylenes
  • Recurrence
  • Registries
  • Reoperation
  • Surgical Mesh*
  • Sweden
  • Young Adult


  • Polypropylenes