Hernia Recurrence Risk Matters More Than Mesh Type to Patients Undergoing Ventral Hernia Repair

Patients' perceptions about synthetic mesh for ventral hernia repair (VHR) may stem from a lack of knowledge of risks. We assessed patients' threshold for accepting the risk of hernia recurrence to avoid synthetic mesh.

Patients ≥18 y old with prior or upcoming VHR viewed a one-time video decision aid describing recurrence risk with biologic versus synthetic mesh. Patients chose between these options using a probability trade-off (PTO) technique, varying hernia recurrence rate with biologic mesh. Based on randomized trials, the recurrence rate using synthetic mesh was 9%. The PTO score was the recurrence rate (0%-100%) at which patients would no longer choose biologic mesh. The process was repeated, including expected wound complications with each mesh. Linear regression identified factors associated with higher PTO scores (risk aversion to synthetic mesh).

Of 100 patients, 57% always preferred synthetic mesh, 3% accepted a higher recurrence risk to have synthetic mesh, and 24% preferred biologic mesh but only if the recurrence rate was lower than with synthetic mesh. In addition, 15% accepted a higher recurrence risk to have biologic mesh, and 1% always preferred biologic mesh despite a higher hernia recurrence rate. Information on wound complications had little impact on mesh choice. On multivariable analysis, higher education and postoperative interviews were associated with higher PTO thresholds.

Contrary to the common belief that patients prefer to avoid synthetic mesh, this study showed that most patients prioritized reducing hernia recurrence risk over mesh type. Further studies should identify patient's goals and priorities for outcomes following VHR.