Does the Type of Permanent Mesh Matter for Inguinal Hernia Repair?

Inguinal hernia repair (IHR) is one of the most performed general surgery procedures in the United States, with more than 700,000 cases annually. There are limited data on the clinical outcomes based on the type of mesh (polyester or polypropylene) used in IHR. This study aims to bridge the knowledge gap on clinical outcomes for polyester and polypropylene mesh used for open and minimally invasive IHR. A retrospective review of prospectively collected data from Abdominal Core Health Quality Collaborative (ACHQC) of all adult patients (Age ≥ 18 and ≤ 90 years) who underwent initial elective IHR (2014–2024) with or without mesh. Univariate and multivariate analyses were performed comparing mesh-based repair with no-mesh repair as the control group. From 37,262 patients with initial elective IHR, 25,331 had polypropylene mesh, 8391 had polyester mesh, and 1770 had no-mesh repair. At 30-day follow-up, polypropylene and polyester had lower readmission (0.8% and 0.7% vs 1.3%;p < 0.05) but higher surgical site occurrences (SSO) (5.3% and 5.5% vs 2.2%;p < 0.05) compared to no-mesh repair. At 1-year follow-up, polypropylene and polyester had lower recurrence compared to no-mesh repair (6.4% and 6.6% vs 11%; p < 0.05). Additional analyses demonstrated similarly lower recurrence with polyester mesh. On logistic regression, polyester (OR 0.4,CI 0.28–0.69) and polypropylene (OR 0.4,CI 0.27–0.57) were protective against recurrence with similar SSO for polyester (OR 1.9,CI 1.01–3.51) and polypropylene (OR 1.9,CI 1.06–3.51) compared to no-mesh repair. Polyester (OR 0.4,CI 0.31–0.56) and polypropylene (OR 0.5,CI 0.39–0.65) had lower ≥6-month EuraHS-QoL pain score compared to no-mesh repair. No statistically significant difference for polyester versus polypropylene based on surgical approach. There was no difference in the 30-day SSO or 1-year hernia recurrence for polyester and polypropylene, irrespective of the surgical approach. Contrary to generalized belief, synthetic mesh-based posterior approach repair may be protective against chronic pain. This highlights the need to focus on surgeon preference and resource utilization that could impact practice guidelines.