Similar recurrence rates among the 10 most used meshes for laparoscopic groin hernia repair: a nationwide register-based cohort study

PURPOSE: Mesh-based repairs are the standard treatment for groin hernias. The effectiveness of mesh materials in laparoscopic groin hernia repair remains a concern and guidelines recommend a laparoscopic procedure with a heavy-weight mesh for adult patients. The objective was to assess the performance of the ten most used meshes for laparoscopic transabdominal preperitoneal (TAPP) groin hernia repairs in adults in regards to risk of recurrence.

METHODS: This nationwide register-based cohort study utilized data from the Danish Hernia Database, covering repairs from January 1, 2018, to June 30, 2023, from all surgical departments in Denmark. Patients operated with a TAPP repair with one of the ten most used meshes were included. The primary outcome was the cumulated risk of re-operation for recurrence, analyzed using Kaplan-Meier curves and Cox regression.

RESULTS: The study included 24,542 groin hernia repairs. All meshes showed a cumulated one-year re-operation rate below 1.5% and a five-year rate below 4%. Cox regression demonstrated lower Hazard Ratios for reoperation for some meshes, with several light-weight meshes having the lowest. For large inguinal hernias, no difference in cumulated re-operation rate was found.

CONCLUSION: All ten of the most used meshes used for laparoscopic groin hernia repair in Denmark had less than 1.5% re-operation for recurrence within 12 months and less than 4% after 5 years. Lightweight meshes seemed to have good performance and it is not clear, even for large inguinal hernias, that a heavy mesh carries a benefit regarding the risk of recurrence, which contradicts current guidelines.