Mesh in Elective Hernia Repair: 10-Year Experience with over 6,000 Patients

J Am Coll Surg. 2021 Jul;233(1):51-62. doi: 10.1016/j.jamcollsurg.2021.03.006. Epub 2021 Mar 18.


Background: The use of mesh in hernia repair has faced intense scrutiny, leading patients to become fearful of its use, despite its benefits in reducing hernia recurrence. We report a single institutional experience in performing hernia repair with mesh in terms of hernia-specific outcomes, mesh-related complications, and patient-reported quality of life.

Study design: Patients who underwent abdominal wall hernia repair with mesh at a single institution were identified from a prospectively maintained quality database. Demographic, perioperative, and postoperative outcomes data were analyzed. Surgical Outcomes Measurements System (SOMS) and Carolinas Comfort Scale (CCS) surveys were administered pre- and postoperatively at 3 weeks, 6 months, 1, 2, and 5 years.

Results: Between 2010 and 2020, a total of 6,387 patients underwent abdominal hernia repair with mesh. Inguinal hernia repairs made up the majority (65%) of the operations. Rates of mesh infection varied by hernia type, with lower rates after umbilical (0.0%) and inguinal (0.4%) repair, and highest after incisional repair (1.3%). Similarly, mesh explantation rates were low after umbilical and inguinal repair (0.0% and 0.4%, respectively) and highest after incisional repair (3.0%). Scores on all SOMS domains were significantly improved from baseline (all p < 0.05). On CCS, 2.9%, 3.3%, and 4.4% of patients reported severe or disabling symptoms postoperatively at 1, 2, and 5 years, respectively.

Conclusions: Rates of mesh-related complications vary by hernia type. A majority of patients report excellent long-term quality of life, although a relatively large percentage of patients experience severe or disabling symptoms at long-term follow-up.

MeSH terms

  • Databases, Factual
  • Device Removal
  • Elective Surgical Procedures
  • Hernia, Abdominal / surgery*
  • Herniorrhaphy / adverse effects
  • Herniorrhaphy / methods*
  • Humans
  • Incisional Hernia / surgery
  • Patient Reported Outcome Measures
  • Reoperation
  • Surgical Mesh* / adverse effects
  • Treatment Outcome