Mesh removal in groin hernia surgery: A long-term nationwide population-based register study

Background

Nowadays, groin hernia repair with mesh is a gold standard procedure in western countries. Yet, foreign body reaction and mesh infection are feared complications. This study aimed to investigate the prevalence and risk factors for mesh removal due to foreign body reaction and mesh infection after groin hernia repair.

Method

This is an observational nationwide population-based register study with the use of prospectively collected data from the Swedish Hernia Register. All patients 15 years or older with a groin hernia repair registered between 1992 and 2022 were eligible. The primary outcome was the prevalence of re-surgery with mesh removal. The secondary outcome was risk factors for re-surgery with mesh removal.

Results

Of 363,664 groin hernia repairs during this 30-year-long study period, 211 (0.06%) had a re-surgery with mesh removal. The proportion of female groin hernia repairs was higher in the mesh removal group (15.2%) compared with the nonmesh removal group (7.9%). The adjusted multivariable Cox regression analysis for the risk of re-surgery with mesh removal demonstrated significantly increased hazard ratios for female (2.80, confidence interval: 1.70–4.63), emergency (3.43, confidence interval: 1.94–6.03), open anterior mesh (2.76, confidence interval: 1.61–4.72), and combined anterior/posterior mesh (predominately mesh plugs) (3.98, confidence interval: 1.84–8.57) groin hernia repairs, and for patients below the total median of 63 years (2.61, confidence interval: 1.78–3.81).

Conclusion

The groin tissue's tolerance for an implanted mesh after a groin hernia repair can be considered high where re-surgery for mesh removal due to foreign body reaction and mesh infection is rare. Female sex, younger patients, emergency repairs, and mesh plugs were most evident associated risk factors for such re-surgery.