Recurrence rate and mesh bulging are reduced with primary fascial closure in ventral hernia repair: the PROSECO randomized clinical trial

Aiolfi A, Cavalli M, Ferraro SD, Manfredini L, Bonitta G, Bruni PG et al.
Ann Surg 2021; 274: 954-961.

Some 35 trials covering the three main methods of inguinal hernia were included, with a total of 7777 patients. Hernia recurrence rates were similar across all methods. Pain within 48 hours of surgery, and chronic groin pain were reduced with minimally invasive methods, as were wound complications.

Comment: Minimally invasive hernia repair has short term advantages, but whether the additional costs over open repair are justified remains unknown.

Krpata DM, Petro CC, Prabhu AS. Tastaldi L, Zolin S, Fafaj A et al.
JAMA Surg 2021; 156: 1085-109

This study evaluated two different weights of hernia mesh in 350 procedures. Compared with standard mesh, medium weight polypropylene mesh did not reduce postoperative pain, quality of life or hernia recurrence after one year: 7 versus 8 per cent.

Comment: The weight of mesh seems unimportant.

Rosen MJ, Krpata DM, Petro CC, Carbonell A, Warren J, Poulose BK et al.

JAMA Surg 2022; 157: 293-301.

Synthetic mesh significantly reduced the risk of hernia recurrence after two years compared to biological mesh (5.6 versus 20.5 per cent, P=0.01), as well as being cheaper, in this study of 253 procedures.

Comment: No need for biological mesh in this situation; does it have a role at all?