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Comment & Response
February 7, 2017

Recurrence and Mesh-Related Complications After Incisional Hernia Repair—Reply

Author Affiliations
  • 1Danish Hernia Database, Copenhagen, Denmark
JAMA. 2017;317(5):537. doi:10.1001/jama.2016.20117

In Reply Mesh reinforcement is almost always used in elective repair of an incisional hernia to minimize the risk of recurrence,1 as well as in repair of small umbilical and epigastric hernias.2 The expert consensus recommendation for the use of mesh was based on evidence from randomized trials from specialized hernia centers with high internal validity and from clinical nationwide prospective databases reporting “real-world” outcomes with high external validity. The fact that reoperation for clinical recurrence underestimates clinical recurrence by a factor of 3 to 4 makes the advantages of mesh reinforcement even larger. Additionally, laparoscopic or open repair carries a risk of approximately 10% for early surgical complications (5% severe),3 further emphasizing the need for mesh reinforcement to limit the risk of a later reoperation for recurrence. However, as shown in our study, the use of mesh reinforcement is not risk free. We found mesh-related complications in 5% of patients after 5 years.