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Updated: May 7, 2026
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Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair
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Association Between Mesh Placement and Recurrence and Chronic Pain After Incisional Hernia Repair: A Systematic
Camilla Witthøft1, Usamah Ahmed1, Evy Á Lakjuni Guttesen1
1Center for Perioperative Optimization, Department of Surgery, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark.
World Journal of Surgery
|May 6, 2026
Summary
Retromuscular mesh placement may reduce incisional hernia recurrence compared to onlay. However, evidence is limited by heterogeneity, and chronic pain requires further study.
Area of Science:
- Surgical Innovation
- Hernia Repair Techniques
- Biomaterials in Surgery
Background:
- Incisional hernia repair recurrence and chronic pain present significant challenges.
- Optimal mesh placement strategies remain incompletely understood.
- This review addresses the evidence gap regarding mesh placement and outcomes.
Purpose of the Study:
- To compare recurrence and chronic pain risks associated with different mesh placements in incisional hernia repair.
- To synthesize evidence from randomized controlled trials and cohort studies.
- To inform clinical decision-making for incisional hernia repair.
Main Methods:
- Systematic literature search of PubMed, Embase Ovid, and Cochrane CENTRAL.
- Inclusion of adult elective incisional hernia repair studies with defects <10 cm.
- Network meta-analysis to compare recurrence rates across mesh placements; risk of bias assessment using Cochrane tools.
Main Results:
- Twenty-two studies involving 10,832 patients were analyzed.
- Retromuscular (3.0%) and preperitoneal (12.8%) mesh placements showed the lowest and highest crude recurrence rates, respectively.
- Network meta-analysis indicated retromuscular and intraperitoneal placements were associated with lower recurrence risk than onlay, though evidence certainty was very low.
Conclusions:
- Retromuscular mesh placement may offer a reduced risk of incisional hernia recurrence compared to onlay.
- Clinical and statistical heterogeneity across studies limits the confidence in current findings.
- Further research is needed to elucidate the relationship between mesh placement and chronic pain outcomes.
