Lightweight polypropylene mesh is associated with higher long-term recurrence after open ventral hernia repair.

IF 3.2 2区医学 Q1 SURGERY

Surgery Pub Date : 2026-09-03 DOI:10.1016/j.surg.2026.110609

Samantha W Kerr, Lucy R Hinton, Gregory T Scarola, Sullivan A Ayuso, Kent W Kercher, Vedra A Augenstein, B Todd Heniford

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引用次数: 0

Abstract

Background: Mesh selection in ventral hernia repair remains controversial. Lightweight mesh was developed as a replacement for heavier meshes to reduce foreign body response and improve abdominal wall compliance, but concerns regarding durability remain. This study evaluated long-term recurrence rates after open ventral hernia repair using lightweight mesh versus midweight mesh.

Methods: A prospectively maintained tertiary hernia center database was queried for elective open ventral hernia repair performed with lightweight mesh or midweight mesh. Propensity-score matching (1:1) was performed using body mass index, Centers for Disease Control and Prevention wound class, and defect size. Multivariable regression determined independent predictors of recurrence. A Kaplan-Meier survival curve modeled recurrence-free survival.

Results: Propensity score matching yielded 310 patients as 155 well-matched pairs. Lightweight mesh versus midweight mesh had similar average age (56.4 ± 13.3 vs 57.0 ± 12.4 years), body mass index (33.6 ± 8.1 vs 33.5 ± 8.4 kg/m²), smoking status (current: 2.6% vs 10.3%; former: 7.7% vs 14.2%), and diabetes (19.4% vs 26.5%) (all P > .05), though lightweight mesh patients had fewer comorbidities (3.3 ± 2.3 vs 4.1 ± 2.0; P = .001). Defect size (123.7 ± 149.5 vs 123.1 ± 140.5 cm²; P = .956) and mesh size (716.2 ± 402.7 vs 708.0 ± 434.3 cm²; P = .445) were similar, and mesh was placed in the preperitoneal plane in most cases (80.0% vs 80.0%; P = .119). There was no statistical difference in average length of stay (5.1 ± 5.9 vs 4.9 ± 3.6 days; P = .608), wound complications (21.9% vs 24.5%; P = .591), 30-day reoperations (3.2% vs 2.6%; P > .999), or mesh infections (0.0% vs 0.6%). Lightweight mesh had significantly higher recurrence rates (12.9% vs 1.9%; P < .001) over an extended follow-up (63.3 ± 61.6 vs 49.2 ± 52.8 months; P = .257). Multivariable regression demonstrated that lightweight mesh was 6.57x more likely to recur than midweight mesh (odds ratio, 6.57; 95% confidence interval, 1.69-25.59; P = .007).

Conclusion: Mesh selection is an important consideration for durable ventral hernia repair. Lightweight mesh should be avoided in open ventral hernia repair, given its high rate of long-term recurrence compared with midweight mesh.

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轻型聚丙烯补片与开放性腹疝修补术后较高的长期复发率有关。

背景：腹疝修补中补片的选择仍然存在争议。轻质网片被开发为较重网片的替代品，以减少异物反应并改善腹壁顺应性，但对耐久性的担忧仍然存在。本研究评估了使用轻型补片和中等重量补片进行开放式腹疝修补后的长期复发率。方法：查询前瞻性维持三级疝中心数据库，选择使用轻型补片或中等重量补片进行开放式腹疝修补。采用身体质量指数、疾病控制与预防中心伤口分级和缺陷大小进行倾向评分匹配（1:1）。多变量回归确定了复发的独立预测因子。Kaplan-Meier生存曲线模拟无复发生存。结果：倾向评分匹配产生310例患者，155对匹配良好。轻量级补片与中等重量补片的平均年龄（56.4±13.3 vs 57.0±12.4岁）、体重指数（33.6±8.1 vs 33.5±8.4 kg/m2）、吸烟状况（当前：2.6% vs 10.3%；前：7.7% vs 14.2%）和糖尿病（19.4% vs 26.5%）相似（P均为0.05），尽管轻量级补片患者的合并症较少（3.3±2.3 vs 4.1±2.0;P = 0.001）。缺损大小（123.7±149.5 vs 123.1±140.5 cm2; P = .956）和补片大小（716.2±402.7 vs 708.0±434.3 cm2; P = .445）相似，补片多放置在腹膜前平面（80.0% vs 80.0%; P = .119）。在平均住院时间（5.1±5.9天vs 4.9±3.6天；P = 0.608）、伤口并发症（21.9% vs 24.5%; P = 0.591）、30天再手术（3.2% vs 2.6%; P = 0.999）或补片感染（0.0% vs 0.6%）方面，两组比较无统计学差异。在延长随访期间（63.3±61.6个月vs 49.2±52.8个月；P = 0.257），轻型补片的复发率明显更高（12.9% vs 1.9%; P < 0.001）。多变量回归显示，轻质网状物复发的可能性比中等重量网状物高6.57倍（优势比为6.57；95%可信区间为1.69-25.59;P = .007）。结论：补片的选择是腹疝持久修补的重要考虑因素。与中等重量的补片相比，轻型补片的长期复发率高，因此在开放式腹疝修补中应避免使用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Surgery 医学-外科

CiteScore

5.40

自引率

5.30%

发文量

687

审稿时长

64 days

期刊介绍： For 66 years, Surgery has published practical, authoritative information about procedures, clinical advances, and major trends shaping general surgery. Each issue features original scientific contributions and clinical reports. Peer-reviewed articles cover topics in oncology, trauma, gastrointestinal, vascular, and transplantation surgery. The journal also publishes papers from the meetings of its sponsoring societies, the Society of University Surgeons, the Central Surgical Association, and the American Association of Endocrine Surgeons.