The optimal mesh weight in onlay repair depends on ventral hernia type: a nationwide register-based cohort study

The aim was to investigate which mesh weight interval was associated with the lowest risk of recurrence for patients with incisional and primary ventral hernias undergoing onlay repair.

Prospectively collected data were obtained from the Danish Ventral Hernia Database, which was linked to the Danish National Patient Registry and the Danish Civil Registration System to ensure complete follow-up of included patients. Data were gathered from January 1, 2007, to April 18, 2024. Multiple exploratory Cox regressions were performed to determine which mesh weight interval was associated with the lowest risk of reoperation for recurrence.

In total, 10,174 patients were included in the study; of these, 1,966 had incisional hernias and 8,208 had primary ventral hernias, which were considered separately in two different cohorts. For patients with incisional hernias, the mesh weight interval of 50-65 g/m² resulted in the lowest reoperation rate compared with 16-49 g/m² (HR = 1.75 (1.06-2.89), p = 0.028) and with 66-110 g/m² (HR = 2.05 (1.19-3.54), p = 0.009). For patients with primary ventral hernias, meshes weighing > 35 g/m² resulted in the lowest risk of reoperation for recurrence compared with < 35 g/m² (HR = 2.15 (1.38-3.35), p < 0.001).

For open onlay ventral hernia repair, mesh weighing 50-65 g/m² resulted in the lowest risk of recurrence for incisional hernias, while mesh weighing > 35 g/m² resulted in the lowest risk of recurrence for primary ventral hernias.