The invite study: incisional hernia prevention: prophylactic mesh from the patient's perspective.

Purpose: Mesh-augmented abdominal wall closure (Mesh prophylaxis) reduces incisional hernia rates in high-risk patients. In spite of a large body of evidence supporting its efficacy and safety, use of mesh prophylaxis is low in the US and UK, possibly due to negative perceptions of surgical mesh^(1-2). This study aimed to assess the acceptability of mesh to patients and determine factors that influence acceptability.

Methods: Following ethical approval, a convergent mixed-methods study was conducted whereby patients who had undergone elective or emergency surgery (n=332) were approached to participate in a questionnaire assessing knowledge and opinions regarding mesh prophylaxis Semi-structured interviews were conducted in a subset of participants (n=12) and thematic analysis performed.

Results: 120 questionnaires were returned with a response rate of 36.1%. The majority (61.8%) of participants had heard of surgical mesh, with half (51.7%) having a negative association, driven by the media. Half (50%) of participants had pre-existing concerns about mesh, however the majority (91%) felt mesh prophylaxis to be acceptable, findings which were echoed in the qualitative component. Analysis of interview data identified three themes: "Knowledge of mesh" and "Acceptability of mesh", which triangulated with findings in the survey data and "Shared decision-making", which explored how participants wanted to receive information about mesh. Factors affecting acceptability of mesh included the nature of information given to patients, and the way in which it was delivered.

Conclusions: Despite negative pre-conceptions, mesh prophylaxis is broadly acceptable to patients. The results of this work will be used to develop patient resources to support mesh prophylaxis. Future mixed-methods studies identifying the surgeons' barriers to use of mesh are needed to allow targeted implementation of prophylactic mesh.