FROM THE AMERICAN JOURNAL OF SURGERY
Compared with midweight mesh, lightweight mesh was associated with more surgical site infection and longer hospital stay following open ventral hernia repair, according to a report published in the American Journal of Surgery.
In addition, lightweight mesh was associated with greater pain, more limitation of movement, and poorer quality of life for up to 2 years after the procedure, compared with midweight mesh.
These findings suggest that it may be advisable to avoid using lightweight mesh in these procedures. “Our group no longer uses lightweight mesh for the repair of ventral incisional hernias,” and now uses midweight mesh almost exclusively, said Steven A. Groene, MD, and his associates at the Carolinas Laparoscopic and Advanced Surgery Program, Carolinas Medical Center, Charlotte, N.C.
Approximately 250,000 open ventral hernia repairs are performed in the Unites States each year, and mesh is used in 85% or more. Since heavyweight mesh was found to reduce abdominal wall mobility, which led to chronic discomfort in about 20% of cases, manufacturers turned to mesh that was more flexible, had reduced mass to decrease foreign-body reactions, but was strong enough to withstand the physiological stress that the abdominal wall is subjected to, the investigators noted.
They compared outcomes after hernia repairs using lightweight and midweight mesh by analyzing information in the International Hernia Mesh Registry database, which covers more than 30 medical centers in 10 countries. For this study, the researchers focused on 549 patients for whom surgeons had selected lightweight (34.2%) or midweight (47.7%) mesh. (The remaining 18.1% of cases used heavyweight mesh.)
Across the study groups, patients were similar for gender distribution; body mass index; race; and the presence of chronic obstructive pulmonary disease, asthma, and immunosuppression – factors that can heavily influence wound repair.
In an initial analysis of the data, midweight mesh was associated with significantly fewer superficial surgical site infections (1.2%) than lightweight mesh (4.8%), as well as a significantly shorter length of stay (3.6 days vs 5.3 days). However, rates of postoperative abdominal wall complications, abscesses, urinary tract infection, pneumonia, hematoma formation, seroma formation, ileus, deep vein thrombosis, and unplanned returns to the operating room were similar.
At 6-month follow-up, lightweight mesh was associated with significantly greater mesh sensation, abdominal discomfort, and movement limitation, as well as significantly worse overall quality of life (QOL), than midweight mesh. At 12 months, lightweight mesh was associated with significantly greater pain and limitation of movement and significantly worse QOL. At 24 months, lightweight mesh continued to be associated with movement limitation, but scores on other measures were similar to those with midweight mesh.
In a multivariate analysis that controlled for many potentially confounding variables, including smoking status, separation of the components of the mesh, the number of sutures anchoring the mesh, and the mesh location within the abdomen, midweight mesh was not associated with worse QOL scores at any time point. In contrast, lightweight mesh was associated with significantly worse QOL scores at 6 months, with an odds ratio of 2.64, and with significantly more pain at 12 months, with an OR of 2.58, Dr. Groene and his associates said ( Am J Surg. 2016 Dec;212[6]:1054-62 ).
The investigators also noted that among their own hernia repair patients, lightweight mesh tends to fracture more easily than midweight mesh. Recent studies also have reported that over time, lightweight mesh is more likely to fail due to fracturing than midweight mesh, they added.
This study had no relevant financial relationships or sources of support. Dr. Groene and his associates reported having no financial conflicts of interest.
