To the Editor In their observational study, Dr Kokotovic and colleagues1 suggested that the benefits of mesh for abdominal wall incisional hernia repair compared with repair without mesh were offset in the long term in part by mesh-related complications. We believe the study has serious methodological shortcomings.
When data are aggregated without appropriate risk adjustment, erroneous conclusions may be drawn. By not risk adjusting the comparison of suture vs mesh repair for their primary outcome of reoperation for hernia recurrence, the authors demonstrated a diminished effect size of the benefits of mesh repair compared with other high-quality studies.2,3 Only through randomization or appropriate risk adjustment (including relevant variables such as hernia characteristics, patient comorbidities, and surgical technique) can an unbiased comparison between mesh and suture repair be made.
Cherla D, Hope W, Liang MK. Recurrence and Mesh-Related Complications After Incisional Hernia Repair. JAMA. 2017;317(5):536–537. doi:10.1001/jama.2016.20112
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