Using mesh to reinforce hernia repair may reduce the risk of re-operation, but carries its own risk of complications, according to a Danish study.
Dr Dunja Kokotovic of Zealand University Hospital, Denmark, and colleagues point out that elective incisional hernia repair is one of the most commonly performed general surgical operations.
Mesh placement is used in at least half of cases as an adjunct to hernia repair, because it is believed to reduce the risk of recurrence. However, the long-term complications related to mesh placement are not known.
The researchers carried out a study of 3,242 male and female patients undergoing incisional hernia repair in hospitals across Denmark. One group had hernia repair using mesh performed by either open or laparoscopic techniques, and the other had open repair without use of mesh.
Mesh repair was linked with a lower risk of needing a reoperation for hernia recurrence over the subsequent five years. The rate was 12% with open mesh repair, 11% for laparoscopic mesh repair, and 17% for non-mesh repair.
On the other hand, long-term mesh-related complications occurred with increasing frequency as time went on. These included bowel obstruction, bowel perforation, bleeding, and late abscess. After five years, the rate was 6% for open mesh hernia repair and 4% for laparoscopic mesh repair.
Findings were published yesterday (18 October) in JAMA. "Mesh implantation prevented the need for subsequent reoperation in relatively few patients, suggesting that the benefits associated with the use of mesh are partially offset by long-term complications associated with its use," the authors write.
"The present study highlights the need to assess the long-term safety of interventions before making definitive conclusions about their benefits."
Kokotovic, D. et al. Long-term Recurrence and Complications Associated With Elective Incisional Hernia Repair. JAMA 18 October 2016; doi:10.1001/jama.2016.15217 [abstract]
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