Comparison of medium-weight vs heavy-weight mesh in minimally invasive extraperitoneal ventral hernia repairs

Background Minimally invasive (MIS) extraperitoneal ventral hernia repair (VHR) has become increasingly common, however, limited data exist comparing medium-weight (MW) versus heavyweight (HW) mesh in this setting. We hypothesized that HW mesh in this context would be associated with decreased rates of hernia recurrence at 1 year and beyond compared to MW mesh. Methods We conducted a retrospective analysis of prospectively collected data from the Abdominal Core Health Quality Collaborative database, identifying adults who underwent MIS extraperitoneal (preperitoneal and/or retromuscular) VHR with either MW (40–60 g/m 2 ) or HW (> 75 g/m 2 ) uncoated permanent synthetic mesh from the inception of the registry to May 2025, with ≥1 year clinical or patient-reported follow-up. Propensity score matching was used to adjust for imbalances in baseline patient characteristics. The primary outcome was 1-year pragmatic hernia recurrence, defined as recurrence based on available elements of patient-reported, clinical and/or radiographic recurrence. Secondary outcomes included 30-day surgical site infection (SSI), surgical site occurrences (SSO), surgical site occurrences requiring procedural intervention (SSOPI). Results 821 patients were identified. After propensity score matching, 238 patients remained (119 MW, 119 HW). Most baseline covariates were well-matched. Patients with umbilical hernias were more likely to receive MW mesh (80% vs. 65%, p =0.009), while patients receiving HW mesh were more likely to have subxiphoid hernias (5.9% vs 15%, p =0.020). There were no documented SSI at 30 days. The rates of SSO ( p =0.696), SSOPI ( p =0.498), and 30-day reoperation ( p =0.999) were similar between groups. At 1-year, pragmatic recurrence was similar between MW and HW patients (7.6% vs 12.6%, p =0.196). Conclusions MW and HW mesh demonstrate comparable early and mid-term outcomes following MIS extraperitoneal VHR. Further prospective study and long-term follow-up are necessary as these techniques proliferate.