Lightweight polypropylene mesh is associated with higher long-term recurrence after open ventral hernia repair

Mesh selection in ventral hernia repair remains controversial. Lightweight mesh was developed as a replacement for heavier meshes to reduce foreign body response and improve abdominal wall compliance, but concerns regarding durability remain. This study evaluated long-term recurrence rates after open ventral hernia repair using lightweight mesh versus midweight mesh.

A prospectively maintained tertiary hernia center database was queried for elective open ventral hernia repair performed with lightweight mesh or midweight mesh. Propensity-score matching (1:1) was performed using body mass index, Centers for Disease Control and Prevention wound class, and defect size. Multivariable regression determined independent predictors of recurrence. A Kaplan-Meier survival curve modeled recurrence-free survival.

Propensity score matching yielded 310 patients as 155 well-matched pairs. Lightweight mesh versus midweight mesh had similar average age (56.4 ± 13.3 vs 57.0 ± 12.4 years), body mass index (33.6 ± 8.1 vs 33.5 ± 8.4 kg/m²), smoking status (current: 2.6% vs 10.3%; former: 7.7% vs 14.2%), and diabetes (19.4% vs 26.5%) (all P > .05), though lightweight mesh patients had fewer comorbidities (3.3 ± 2.3 vs 4.1 ± 2.0; P = .001). Defect size (123.7 ± 149.5 vs 123.1 ± 140.5 cm²; P = .956) and mesh size (716.2 ± 402.7 vs 708.0 ± 434.3 cm²; P = .445) were similar, and mesh was placed in the preperitoneal plane in most cases (80.0% vs 80.0%; P = .119). There was no statistical difference in average length of stay (5.1 ± 5.9 vs 4.9 ± 3.6 days; P = .608), wound complications (21.9% vs 24.5%; P = .591), 30-day reoperations (3.2% vs 2.6%; P > .999), or mesh infections (0.0% vs 0.6%). Lightweight mesh had significantly higher recurrence rates (12.9% vs 1.9%; P < .001) over an extended follow-up (63.3 ± 61.6 vs 49.2 ± 52.8 months; P = .257). Multivariable regression demonstrated that lightweight mesh was 6.57x more likely to recur than midweight mesh (odds ratio, 6.57; 95% confidence interval, 1.69-25.59; P = .007).

Mesh selection is an important consideration for durable ventral hernia repair. Lightweight mesh should be avoided in open ventral hernia repair, given its high rate of long-term recurrence compared with midweight mesh.