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Updated: May 26, 2026
Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair
Published on: December 23, 2022
Mesh placement and risk of reoperation for recurrence after incisional hernia repair: a nationwide register-based
Camilla Witthøft1, Usamah Ahmed2, Jacob Rosenberg2
1Center for Perioperative Optimization, Department of Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark. camillawitthoft@outlook.dk.
Purpose:
Retromuscular mesh placement is recommended for incisional hernia repair, but the current certainty of evidence remains low. This study aimed to compare the risk of reoperation for recurrence among adults undergoing incisional hernia repair with onlay, retromuscular, preperitoneal, and intraperitoneal onlay mesh (IPOM).
Methods:
This study used prospectively collected data from the Danish Ventral Hernia Database that were linked to the Danish National Patient Register and the Danish Civil Registration System. We included patients undergoing elective incisional hernia repair with defect widths ≤ 10 cm operated between 2007 and 2025. The primary outcome was reoperation for recurrence, analyzed using Cox regression, and included subgroup analyses of defect width, surgical approach, and type of previous incision.
Results:
In total, 5,375 patients were included, of whom 14% received a preperitoneal mesh placement, 22% retromuscular placement, 30% IPOM with defect closure, and 34% onlay placement. Compared with preperitoneal placement, onlay was associated with a higher risk of reoperation (HR 2.62, 95% CI 1.73-3.95; p < 0.001). Onlay was associated with a higher risk than all other placements. However, this association was not observed in subgroup analyses for defect widths ≤ 2 cm (p = 0.058), in which retromuscular placement was associated with a significantly increased risk of reoperation.
Conclusion:
Onlay mesh placement for defect widths > 2 cm and retromuscular mesh placement for defect widths ≤ 2 cm were associated with higher risk of reoperation for recurrence.
