Brandon Cowan, Priscilla H Chan, Sahil S Patel, Heather A Prentice, Kenneth Sucher, Elizabeth W Paxton, Elliott R Brill, Lavina Malhotra, Francisca M Maertens, Gregory M Heitmann, Rouzbeh Mostaedi
{"title":"补片重量与不良结果的关联:一项包括123,880例腹股沟疝修补术的队列研究。","authors":"Brandon Cowan, Priscilla H Chan, Sahil S Patel, Heather A Prentice, Kenneth Sucher, Elizabeth W Paxton, Elliott R Brill, Lavina Malhotra, Francisca M Maertens, Gregory M Heitmann, Rouzbeh Mostaedi","doi":"10.1007/s10029-025-03427-3","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Surgeons lack conclusive evidence to guide mesh choice for inguinal hernia repair. We sought to evaluate risk for recurrence, reoperation, and chronic postoperative inguinal pain (CPIP) compared among different mesh weight classes.</p><p><strong>Methods: </strong>We conducted a cohort study including 123,880 repairs in adult patients who underwent first elective mesh-based inguinal hernia repair within a US integrated healthcare system (1/2010-6/2023). Mesh weight was categorized into lightweight (LW, < 50 g), medium-weight (MW, 50-90 g), and heavyweight (HW, > 90 g). Recurrence and reoperation during follow-up were primary outcomes while 5-year CPIP was a secondary outcome. Multivariable Cox regression was used to evaluate risk of primary outcomes, while multivariable logistic regression was used to evaluate the secondary outcome; all models included covariate adjustment and stratified by surgery type.</p><p><strong>Results: </strong>LW, MW, and HW mesh were used in 49.0% (n = 23,685), 3.8% (n = 1,811), and 47.2% (n = 22,815) of minimally invasive (MIS) procedures, respectively; and were used in 55.7% (n = 42,097), 25.4% (n = 19,183), and 18.9% (n = 14,289) of open procedures, respectively. Among MIS repairs, LW mesh was associated with a lower risk of recurrence, reoperation, and CPIP versus HW, and a lower risk of recurrence and reoperation versus MW. Among open repairs, no difference was seen between LW and MW for recurrence, reoperation, and CPIP, while HW had a lower risk for recurrence and reoperation, but a higher likelihood of CPIP compared to LW.</p><p><strong>Conclusion: </strong>LW mesh was associated with a long-term advantage with fewer postoperative complications for MIS repair. HW mesh was associated with higher CPIP risk following an open repair.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"258"},"PeriodicalIF":2.4000,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Association of mesh weight with adverse outcomes: a cohort study including 123,880 inguinal hernia repairs.\",\"authors\":\"Brandon Cowan, Priscilla H Chan, Sahil S Patel, Heather A Prentice, Kenneth Sucher, Elizabeth W Paxton, Elliott R Brill, Lavina Malhotra, Francisca M Maertens, Gregory M Heitmann, Rouzbeh Mostaedi\",\"doi\":\"10.1007/s10029-025-03427-3\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Surgeons lack conclusive evidence to guide mesh choice for inguinal hernia repair. We sought to evaluate risk for recurrence, reoperation, and chronic postoperative inguinal pain (CPIP) compared among different mesh weight classes.</p><p><strong>Methods: </strong>We conducted a cohort study including 123,880 repairs in adult patients who underwent first elective mesh-based inguinal hernia repair within a US integrated healthcare system (1/2010-6/2023). Mesh weight was categorized into lightweight (LW, < 50 g), medium-weight (MW, 50-90 g), and heavyweight (HW, > 90 g). Recurrence and reoperation during follow-up were primary outcomes while 5-year CPIP was a secondary outcome. Multivariable Cox regression was used to evaluate risk of primary outcomes, while multivariable logistic regression was used to evaluate the secondary outcome; all models included covariate adjustment and stratified by surgery type.</p><p><strong>Results: </strong>LW, MW, and HW mesh were used in 49.0% (n = 23,685), 3.8% (n = 1,811), and 47.2% (n = 22,815) of minimally invasive (MIS) procedures, respectively; and were used in 55.7% (n = 42,097), 25.4% (n = 19,183), and 18.9% (n = 14,289) of open procedures, respectively. Among MIS repairs, LW mesh was associated with a lower risk of recurrence, reoperation, and CPIP versus HW, and a lower risk of recurrence and reoperation versus MW. Among open repairs, no difference was seen between LW and MW for recurrence, reoperation, and CPIP, while HW had a lower risk for recurrence and reoperation, but a higher likelihood of CPIP compared to LW.</p><p><strong>Conclusion: </strong>LW mesh was associated with a long-term advantage with fewer postoperative complications for MIS repair. HW mesh was associated with higher CPIP risk following an open repair.</p>\",\"PeriodicalId\":13168,\"journal\":{\"name\":\"Hernia\",\"volume\":\"29 1\",\"pages\":\"258\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2025-08-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Hernia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s10029-025-03427-3\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hernia","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10029-025-03427-3","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
Association of mesh weight with adverse outcomes: a cohort study including 123,880 inguinal hernia repairs.
Purpose: Surgeons lack conclusive evidence to guide mesh choice for inguinal hernia repair. We sought to evaluate risk for recurrence, reoperation, and chronic postoperative inguinal pain (CPIP) compared among different mesh weight classes.
Methods: We conducted a cohort study including 123,880 repairs in adult patients who underwent first elective mesh-based inguinal hernia repair within a US integrated healthcare system (1/2010-6/2023). Mesh weight was categorized into lightweight (LW, < 50 g), medium-weight (MW, 50-90 g), and heavyweight (HW, > 90 g). Recurrence and reoperation during follow-up were primary outcomes while 5-year CPIP was a secondary outcome. Multivariable Cox regression was used to evaluate risk of primary outcomes, while multivariable logistic regression was used to evaluate the secondary outcome; all models included covariate adjustment and stratified by surgery type.
Results: LW, MW, and HW mesh were used in 49.0% (n = 23,685), 3.8% (n = 1,811), and 47.2% (n = 22,815) of minimally invasive (MIS) procedures, respectively; and were used in 55.7% (n = 42,097), 25.4% (n = 19,183), and 18.9% (n = 14,289) of open procedures, respectively. Among MIS repairs, LW mesh was associated with a lower risk of recurrence, reoperation, and CPIP versus HW, and a lower risk of recurrence and reoperation versus MW. Among open repairs, no difference was seen between LW and MW for recurrence, reoperation, and CPIP, while HW had a lower risk for recurrence and reoperation, but a higher likelihood of CPIP compared to LW.
Conclusion: LW mesh was associated with a long-term advantage with fewer postoperative complications for MIS repair. HW mesh was associated with higher CPIP risk following an open repair.
期刊介绍:
Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery.
Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.