Patient-reported Outcomes According to Mesh Position After Elective Incisional Hernia Repair

OBJECTIVES: The aim of this study was to investigate the association between mesh position and patient-reported outcomes, including prevalence of severe chronic pain, foreign body sensation, self-reported recurrence, and physical impact score in patients undergoing elective incisional hernia repair. BACKGROUND: Patient-reported outcomes are increasingly recognized as important measures of treatment success following incisional hernia repair, yet the impact of mesh position remains uncertain. METHODS: This nationwide Danish survey- and register-based cohort study was conducted within the AFTERHERNIA Project and based on the Abdominal Hernia questionnaire. All patients undergoing elective incisional hernia repair in Denmark between January 1, 2014, and March 31, 2024, were eligible for inclusion. Survey responses were linked with operative data from the Danish Ventral Hernia Database. Adjusted prevalences and means were estimated using g-computation. RESULTS: Of 2827 eligible patients, 2348 patients responded, corresponding to a response rate of 83%. Among these, 28% of patients received onlay, 28% retromuscular, 13% preperitoneal, and 31% intraperitoneal mesh position with defect closure. Onlay was associated with a higher prevalence of foreign body sensation compared with retromuscular position (adjusted prevalence, 37.1% vs. 30.3%; difference, 6.8%; 95% CI, 0.9-12.8). No differences were observed across mesh positions regarding the prevalence of severe chronic pain, self-reported recurrence, and physical impact score. CONCLUSIONS: Onlay position was associated with a higher prevalence of foreign body sensation compared with retromuscular position, while no differences were observed regarding the prevalence of severe chronic pain, self-reported recurrence, or physical impact score.