Comparison of medium-weight vs heavy-weight mesh in minimally invasive extraperitoneal ventral hernia repairs.

Abstract

Background: Minimally invasive (MIS) extraperitoneal ventral hernia repair (VHR) has become increasingly common, however, limited data exist comparing medium-weight (MW) versus heavyweight (HW) mesh in this setting. We hypothesized that HW mesh in this context would be associated with decreased rates of hernia recurrence at 1 year and beyond compared to MW mesh.

Methods: We conducted a retrospective analysis of prospectively collected data from the Abdominal Core Health Quality Collaborative database, identifying adults who underwent MIS extraperitoneal (preperitoneal and/or retromuscular) VHR with either MW (40-60 g/m²) or HW (> 75 g/m²) uncoated permanent synthetic mesh from the inception of the registry to May 2025, with ≥1 year clinical or patient-reported follow-up. Propensity score matching was used to adjust for imbalances in baseline patient characteristics. The primary outcome was 1-year pragmatic hernia recurrence, defined as recurrence based on available elements of patient-reported, clinical and/or radiographic recurrence. Secondary outcomes included 30-day surgical site infection (SSI), surgical site occurrences (SSO), surgical site occurrences requiring procedural intervention (SSOPI).

Results: 821 patients were identified. After propensity score matching, 238 patients remained (119 MW, 119 HW). Most baseline covariates were well-matched. Patients with umbilical hernias were more likely to receive MW mesh (80% vs. 65%, p =0.009), while patients receiving HW mesh were more likely to have subxiphoid hernias (5.9% vs 15%, p =0.020). There were no documented SSI at 30 days. The rates of SSO (p =0.696), SSOPI (p =0.498), and 30-day reoperation (p =0.999) were similar between groups. At 1-year, pragmatic recurrence was similar between MW and HW patients (7.6% vs 12.6%, p =0.196).

Conclusions: MW and HW mesh demonstrate comparable early and mid-term outcomes following MIS extraperitoneal VHR. Further prospective study and long-term follow-up are necessary as these techniques proliferate.