Mesh Removal Due to Foreign Body Reaction and Mesh Infection in Groin Hernia Surgery: A Long-Term Nationwide Population-Based Register Study

Background Groin hernia repairs (GHRs) with mesh is today gold standard procedure in western countries. Yet, foreign body reaction and mesh infection are feared complications. This study aimed to investigate the incidence and risk factors for mesh removal due to foreign body reaction and mesh infection following GHR. Method This is an observational nationwide populations-based register-study with the use of prospectively collected data from the Swedish Hernia Register (SHR). All patients ≥15 years old with a GHR registered in SHR between 1992 and 2022 were eligible. Primary outcome was the incidence of re-surgery for mesh removal. Secondary outcome was risk factors for re-surgery with mesh removal. Results Out of 364 012 GHRs during this 30-years long study-period, 216 (0.059%) had a re-surgery with mesh removal. Mesh removals were more frequently performed in men (85.2%). Median age was 56 years old. 91.2% had earlier been performed electively and 73.1% with a previous open anterior mesh repair. In the adjusted multivariate Cox regression analysis for the risk of re-surgery with mesh removal, significantly increased hazard ratios were estimated for women (2.62, CI 1.61–4.27), emergency GHR (3.88, CI 2.20–6.85), postoperative complications (3.45, CI 2.34–5.08), high ASA class (2.12, CI 1.16–3.88) and age below median (1.59, CI 1.09–2.32). Conclusion The groin tissue tolerance for implanted mesh following GHR is considered high where re-surgery for mesh removal due to foreign body reaction and mesh infection is rare. Women, younger patients, comorbidity, emergency repairs and presence of postoperative complications were associated risk factors for such re-surgery.