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Updated: Aug 3, 2025
Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair
Published on: December 23, 2022
Mediumweight polypropylene mesh fractures after open retromuscular ventral hernia repair: incidence and associated
Sara Maskal1, Benjamin Miller2, Ryan Ellis2
1Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA. Maskals2@ccf.org.
Purpose:
Mediumweight (MW) and heavyweight (HW) polypropylene have demonstrated similar clinical and patient-reported outcomes in the setting of open retromuscular ventral hernia repair (VHR). While MW mesh has an anecdotal risk of central mesh fracture, that phenomenon is not well-characterized. We sought to assess the incidence of and risk factors for MW polypropylene mesh fractures after VHR.
Methods:
The ACHQC registry was queried for patients with CT-documented hernia recurrence after open retromuscular VHR with MW polypropylene mesh at our institution with 1-year follow-up between January 2014 and April 2022. Images were reviewed by five blinded surgeons at Cleveland Clinic to reach consensus that hernia recurrence mechanism was central mesh fracture. Patients without clinical recurrence or patient-reported bulge were used as a comparator group.
Results:
Eighty patients were identified with radiographically documented recurrence; 28 had recurrence from mesh fractures and these were compared to 644 patients without recurrence. Incidence of MW fracture was 4.2%. Bridging of anterior fascia was more common in the group with the central mesh fracture (33.3% vs 3.3%, p < 0.001); the incidence of fracture was 30% (9/30) in patients requiring a bridged closure. Mesh fracture was associated with larger hernias (median width: 20 cm [16-26] vs 15 cm [12-18], p < 0.001,), length (25 cm [23-30] vs 23 cm [19-26], p = 0.004).
Conclusion:
MW polypropylene mechanical failures are surprisingly common, particularly in settings of bridged fascial closure and larger hernias. Use of HW polypropylene should be considered in this setting, and industry should be encouraged to create larger pieces of HW polypropylene mesh.
Insights
Mediumweight polypropylene mesh fractures occur in 4.2% of ventral hernia repairs, especially with larger hernias and bridged closures. Consider heavyweight mesh for these cases.
Area of Science:
- Surgical mesh technology
- Hernia repair outcomes
- Biomaterials science
Background:
- Mediumweight (MW) and heavyweight (HW) polypropylene meshes show similar outcomes in open retromuscular ventral hernia repair (VHR).
- Central mesh fracture is an anecdotal risk with MW mesh, but not well-characterized.
Purpose of the Study:
- To assess the incidence of MW polypropylene mesh fractures after VHR.
- To identify risk factors associated with MW mesh fractures.
Main Methods:
- Querying the ACHQC registry for patients with CT-documented hernia recurrence after open retromuscular VHR with MW polypropylene mesh (Jan 2014 - Apr 2022).
- Reviewing images by five blinded surgeons to confirm central mesh fracture as the recurrence mechanism.
- Comparing patients with mesh fractures to a control group without recurrence.
Main Results:
- The incidence of MW polypropylene mesh fracture was 4.2%.
- Mesh fracture was significantly associated with larger hernias (median width 20 cm vs 15 cm) and longer hernia defects (25 cm vs 23 cm).
- Bridging of anterior fascia was more common in the mesh fracture group (33.3% vs 3.3%), with 30% of bridged closures experiencing fracture.
Conclusions:
- Mediumweight polypropylene mesh mechanical failures are common, particularly in larger hernias and bridged fascial closures.
- Consider using heavyweight polypropylene mesh in these high-risk settings.
- Encourage industry to develop larger pieces of heavyweight polypropylene mesh.
