Optimal Mesh Weight Identified to Reduce Reoperation Risk After Laparoscopic Hernia Repair: JAMA
Denmark: A new nationwide study published in JAMA Surgery has identified an optimal mesh weight range that may significantly reduce the risk of reoperation for recurrence after laparoscopic inguinal hernia repair. The research, led by Can Deniz Deveci and colleagues from the Center for Perioperative Optimization at Copenhagen University Hospital—Herlev and Gentofte, offers crucial insights into a long-debated topic in hernia surgery.
For years, discussions around mesh selection have revolved around the broad classifications of “lightweight” and “heavyweight” materials—categories that were not originally based on clinical outcome data. This study shifts the focus to specific weight intervals and their real-world impact on surgical success.
Drawing on prospectively collected data from the Danish Inguinal Hernia Database, the investigators evaluated outcomes among adult patients who underwent primary transabdominal preperitoneal (TAPP) laparoscopic inguinal hernia repair between 1998 and July 2023. The final analysis included 43,986 hernias in 36,446 patients, grouped according to mesh weight: less than 45 g/m², 45–65 g/m², and more than 65 g/m².
Using registry linkage with the Danish National Patient Registry, researchers were able to track each case until death, emigration, reoperation, or the study’s endpoint. A Cox proportional hazards model was applied to determine which mesh weight range was associated with the lowest likelihood of recurrence requiring reoperation.
The following were the key findings of the study:
- A total of 1,910 hernias (4.34%) required reoperation during follow-up.
- Meshes in the 45–65 g/m² range showed the lowest risk of recurrence requiring reintervention.
- Meshes weighing less than 45 g/m² were associated with a 2.6-fold higher risk of reoperation compared with the 45–65 g/m² group.
- Meshes weighing more than 65 g/m² showed a 2.4-fold increased risk of reoperation compared with the 45–65 g/m² group.
The study’s authors concluded that the optimal mesh weight appears to fall within the 45–60 g/m² range, which offered the most favorable outcomes across exploratory analyses. Selecting a mesh within this interval, they noted, may help surgeons minimize the risk of recurrence and reduce the need for secondary procedures.
These findings are particularly meaningful given the widespread use of laparoscopic repair techniques and the substantial number of patients affected by inguinal hernias. By providing evidence-based guidance on mesh selection, the study has the potential to influence surgical decision-making and improve long-term patient outcomes on a large scale.
"As hernia repair continues to evolve, the research highlights the importance of relying on clinical data rather than convention alone. With nearly 44,000 cases examined over 25 years, the study offers one of the most comprehensive assessments to date on how mesh weight affects recurrence risk after laparoscopic inguinal hernia repair," the authors concluded.
Reference:
Deveci CD, Baker JJ, Rosenberg J. Mesh Weight in Reoperation for Recurrence After Laparoscopic Inguinal Hernia Repair. JAMA Surg. 2025;160(12):1334–1339. doi:10.1001/jamasurg.2025.4328
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