Cowan Brandon, Chan Priscilla H, Patel Sahil S, Prentice Heather A, Sucher Kenneth, Paxton Elizabeth W, Brill Elliott R, Malhotra Lavina, Maertens Francisca M, Heitmann Gregory M, Mostaedi Rouzbeh
University of California San Francisco East Bay Surgery, Oakland, CA, USA.
Medical Device Surveillance and Assessment, Southern California Permanente Medical Group, San Diego, CA, USA.
Hernia. 2025 Aug 26;29(1):258. doi: 10.1007/s10029-025-03427-3.
Surgeons lack conclusive evidence to guide mesh choice for inguinal hernia repair. We sought to evaluate risk for recurrence, reoperation, and chronic postoperative inguinal pain (CPIP) compared among different mesh weight classes.
We conducted a cohort study including 123,880 repairs in adult patients who underwent first elective mesh-based inguinal hernia repair within a US integrated healthcare system (1/2010-6/2023). Mesh weight was categorized into lightweight (LW, < 50 g), medium-weight (MW, 50-90 g), and heavyweight (HW, > 90 g). Recurrence and reoperation during follow-up were primary outcomes while 5-year CPIP was a secondary outcome. Multivariable Cox regression was used to evaluate risk of primary outcomes, while multivariable logistic regression was used to evaluate the secondary outcome; all models included covariate adjustment and stratified by surgery type.
LW, MW, and HW mesh were used in 49.0% (n = 23,685), 3.8% (n = 1,811), and 47.2% (n = 22,815) of minimally invasive (MIS) procedures, respectively; and were used in 55.7% (n = 42,097), 25.4% (n = 19,183), and 18.9% (n = 14,289) of open procedures, respectively. Among MIS repairs, LW mesh was associated with a lower risk of recurrence, reoperation, and CPIP versus HW, and a lower risk of recurrence and reoperation versus MW. Among open repairs, no difference was seen between LW and MW for recurrence, reoperation, and CPIP, while HW had a lower risk for recurrence and reoperation, but a higher likelihood of CPIP compared to LW.
LW mesh was associated with a long-term advantage with fewer postoperative complications for MIS repair. HW mesh was associated with higher CPIP risk following an open repair.
外科医生缺乏确凿证据来指导腹股沟疝修补术的补片选择。我们试图评估不同补片重量等级之间复发、再次手术和慢性术后腹股沟疼痛（CPIP）的风险。
我们进行了一项队列研究，纳入了美国综合医疗系统中（2010年1月至2023年6月）首次接受基于补片的择期腹股沟疝修补术的成年患者的123880例修补手术。补片重量分为轻质（LW，<50克）、中质（MW，50 - 90克）和重质（HW，>90克）。随访期间的复发和再次手术是主要结局，而5年CPIP是次要结局。多变量Cox回归用于评估主要结局的风险，多变量逻辑回归用于评估次要结局；所有模型均包括协变量调整并按手术类型分层。
LW、MW和HW补片分别用于49.0%（n = 23685）、3.8%（n = 1811）和47.2%（n = 22815）的微创手术（MIS）；分别用于55.7%（n = 42097）、25.4%（n = 19183）和18.9%（n = 14289）的开放手术。在MIS修补术中，与HW相比，LW补片与复发、再次手术和CPIP的风险较低相关，与MW相比，LW补片的复发和再次手术风险较低。在开放修补术中，LW和MW在复发、再次手术和CPIP方面没有差异，而HW与LW相比，复发和再次手术风险较低，但CPIP的可能性较高。
LW补片与MIS修补术后并发症较少的长期优势相关。HW补片与开放修补术后较高的CPIP风险相关。
