Mesh placement and patient-reported outcomes in primary ventral hernia repair: a nationwide survey- and register-based study

BACKGROUND: Mesh repair reduces recurrence risk, but evidence regarding patient-reported outcomes (PROs) across mesh placements remains limited. This study aimed to investigate the association between mesh placement and PROs in primary ventral hernia repair, and secondarily the prevalence of severe chronic pain and foreign body sensation. METHODS: This nationwide survey- and register-based study, part of the AFTERHERNIA project in Denmark, linked electronic survey responses with operative data from the Danish Ventral Hernia Database. Adults (≥ 18 years) who underwent elective primary (umbilical or epigastric) ventral hernia repair with mesh between January 1, 2014, and March 31, 2024, were included, limited to defects < 10 cm. PROs were assessed using the validated, ventral hernia-specific Abdominal Hernia-Q (AHQ) questionnaire. RESULTS: Out of 13,327 eligible patients, 10,869 (82%) responded (median age, 54 years; 71% male). Compared with onlay, preperitoneal repair had a better AHQ sum score (58.7 vs 57.7; mean difference, 0.9; 95% CI, 0.6 to 1.2; P < .001), lower prevalence of severe chronic pain (8.7% vs 11.3%; difference, -2.6%; 95% CI, -4.0% to -1.2%; P < .001), and lower prevalence of foreign body sensation (20.1% vs 23.9%; difference, -3.8%; 95% CI, -5.7% to -1.8%; P < .001). Findings were consistent across subgroups and sensitivity analyses. CONCLUSIONS: PROs were generally good across mesh placements. Preperitoneal mesh placement was associated with slightly better PROs compared with other placements, although the difference was small and unlikely to be clinically meaningful. However, it was associated with a lower prevalence of severe chronic pain and foreign body sensation compared with onlay and intraperitoneal mesh.